NURSING

INFORMATICS
Valery C. Lim, MSN
Introduction:
> NI how it is started? NI was started through the
EHR Decade (electronic health record)->
mandated by the President of the United
States and the secretary of Health and Human
Services ( HHS)
NOW NI is
> Moving to the forefront of the nursing
profession and nursing information technology
system
Nurses are becoming and or computer literate
Nursing profession is implementing standards
for its clinical care and data for its nursing
information technology systems.
What is the role of the nurses in NI?
Since nurses are the largest group of professionals that
provide clinical care to patients and consumers advocate-
nurses are qualified as INFORMATION SPECIALISTS-
may serve as.
1. Administrator
2. Researcher
3. Educators and
4. Community health care professionals or work as
5. Computer information officers (CIOs)
6. Corporate executives in vendors companies
7. Implementers of information technology
8. Developers of systems and
9. Consultants

Definition of NI by ANA
NI is
A specialty that integrates nursing science, computer
science and information science to manage and
communicate DATA, INFORMATION and
KNOWLEDGE in nursing practice.
facilitates the integration of data, information and
knowledge to support patients, nurses and other
providers in their decision making in all roles and
settings
Represents the transition of data, and data
information and knowledge into action
Also represents the practice, administration,
community health education and nursing research
application.

NI specialists emerged as a new specialty by
the ANA
Majority of nurses entering the profession is
computer literate
Every health care setting ---acute care
hospital, academic school of nursing, large
community health agency or health care
setting where nurses function---will employ at
least one NI specialist and will implement
some type of a CIS (clinical information
system)

CIS designed to support nursing practice. It
requires an understanding of professional
nursing practice process, technology that is
the application for the science to function
electronically.
CIS that adequately support nursing practice
have not emerged over the past decades--
Major historical perspectives of nursing
and computers..
Major historical perspectives of
nursing and computers
Intro..
Computer technology emerged in nursing in
response to the changing and developing
technologies in health care industry and in nursing
practice. It is analyzed in the ff:
1.SIX TIME PERIODS
2. Four major nursing areas
3. Standards initiatives
4. Significant landmarks and;
5. Major landmarks milestone chart
Six Time Periods
1. Prior to 1960s (starting 1950s)
Nursing profession undergoing major
changes.
Image of nursing was improving, nursing
practices and services were expanding in
scope and complexity and number of nurses
was increasing these events provided for
the profession to embrace computers.
Computers were initially used in health care
facilities for basic business office function.

1 Prior to the 1960s
2. 1960s
3. 1970s
4. 1980s
5. 1990s
6. Post 2000

1.Prior to 1960s (1950)
There were only few experts that attempt to adapt computers
to health care and nursing
Nursing profession was undergoing major changes.
Image of nursing was improving, nursing practices and
services were expanding in scope and complexity, the
number of nurses were increasing.
Computers were initially used in health care facilities for basic
office functions.
These early computers used punch cards to store data and
card readers to read computer programs, sort, and prepare
data for processing. They were linked together and operated
by paper tape and used teletypewriters to print their output.
2.1960s
Used of computer technology in health care
setting began to be questioned. Why
computers? What should be computerized? -
Nursing practice was reviewed and nursing
resources were analyzed.
Studies were conducted to determine how
computer technology could be utilized
effectively in the health care industry and what
areas of nursing should be automated?
Nurses station the most appropriate center
for the development of the computer
applications.
Computer technology advanced so as with the
health care facilities increased.
Introduction of cathode ray tube (CRT)
terminals, online data communication, and
real- time processingadded important
dimensions to the computer system
providing more accessible and user-friendly
machines.
Hospital Information Systems (HISs) were
developed primarily to process financial
transactions and serve as billing and
accounting system. However, few HISs
emergedocument and process limited
number of medical orders and nursing care
activities.
3. 1970s
Continued integration of computers into nursing.
Nurses began to recognize the value of the computer for their
profession.
Nurses recognized the computers potential for improving the
documentation of nursing practice, the quality of patient care,
and the repetitive aspects of managing patient care.
Nurses assisted in the design and development of nursing
applications for the HISs and other environments where
nurses functioned.
Several states (in the USA) and large community health
agencies developed and/or contracted for their own
computer-based management information systems (MISs)
MISs? For Public Health MISs provide
information required by the local, state, and
federal agencies for specific program funds
MIS Home health agencies provided
billing and other financial information required
for reimbursement of patient services by
Medicare, Medicaid, etc.
1980s
The field of informatics emerged in the health
care industry and nursing.
NI became accepted specialty of nursing.
Use of computers in nursing became
revolutionary
The need for nursing software evolved.
Nursing profession needed not only to update
its practice standards but also to determine its
data standards, vocabularies and classification
schemes that could be coded for the
computer-based patient record systems
(CPRs)
Mainframe of MISs emerged with nursing
subsystems- patient record: order entry,
kardex, vital signs, systems that documented
narrative nursing notes via word-processing
packages, discharge planning systems and
used as referrals to community health care
facilities in the continuum of care.
Microcomputer or personal computer (PC)
emerged. made computers more accessible,
affordable and usable by nurses and other
health care providers.
PCs brought computing powers to the
workplace, more importantly to the point of
care.
1990s
Computer technology became an integral part
of health care settings, nursing practice, and
the nursing profession.
Policies and legislation were adopted
promoting computer technology in health care
including nursing.
Nursing profession became actively involved
in promoting NI.
1992 NI was approved ANA as new nursing
specialty- demand for NI expertise increased
greatly in the workplace and other settings
where nurses functioned.
Need? Computer based nursing practice
standards, data standards, nursing minimum
data sets.
Smaller and faster computers laptops and
notebooks- to the bedside, and all of the
point-of- care settings.
Workstations and Local Area Networks (LAN)
were developed for hospital nursing units
Wide Area Networks (WANs)- for linking care
across health care facilities
Internet- started to be used for linking
across the different systems. made it
possible for information and knowledge
databases to be integrated into bedside
systems.
Internet
- for sophisticated information technologies.
1995 E-mail
Facilitates data exchange between CPRs
across the facilities and settings.
Web- became the means for communicating
online services and resources to the nursing
community.
Post-2000
Growth and development of hardware and
software.
The growth is reflected in healthcare and
nursing with developments such as wireless
point-of-care.
Clinical information systems became
individualized in the electronic patient record
(EPR) and specific systems electronic health
record (EHR)
Technology: wireless tablet computer,PDAs,
and smart cellular phones, voice over internet
protocol (VoIP).
Internet provided a means for development of
clinical applications.
Critical care units are monitored remotely by
health care providers.
Home health care increasingly partnered with
information technology for the provision of
patient care.
Telenursing recognized as specialty 1990s
increased in popularity and providing patient
care.
Four major nursing areas
That shaped the need for computers,
information technologies and informatics.
1. Nursing Practice
2. Nursing administration
3. Nursing education
4. Nursing research
Nursing Practice
Became an integral part of the HER
Computer systems with nursing and patient care data, nursing care
plans are no longer separate subsystems of the computerized HISs,
but rather integrated into one interdisciplinary patient health record
(EHR).
Nursing practice data emerged with the introduction of several
nursing terminologies that were recognized by the ANA as coded
terminologies usable for EHR used to assess problems,
document care, track the care process and measures outcome
Electronic version of nursing practice.
Computer revolutionarized and transformed the nursing practice.

Nursing Administration
Changed with the introduction of the computer
that links nursing departments together.
Policy and procedure manuals are accessed
and retrieved by computer.
Nurses have access to digital libraries, online
resources, and research protocols at the
bedside.
Nursing Education
Changed in the nursing education
Schools of nursing offer computer enhanced
courses, online courses, and/or distance
education.
Campus-wide computer system are available
for students to communicate via e-mail,
transfer data file, access digital libraries and
retrieve online resources of millions of Internet
WWW sites.
New educational strategies require different
methods of teaching.
Students have to be more active and assume
more responsibility for their education.
Nursing Research
Software programs are available for both
quantitaive and qualitative research.
Online searching and retrieving information
from the electronic bibliographic literature
systems.
Increased capabilities and expanded the field
of nursing research.
Electronic Health Records
Introduction:
This presentation seeks to highlight the
foundation and purpose of Electronic Health
Records (EHR). This is a new way of storing
and organizing patients medical
information.EHR patient files are divided into
sections where health care providers and staff
can find the information they need to provide
patient care.

CONTENT
Definition
Benefits of EHR
How secure is EHR in patient privacy
Who access patient information


is a digital format or documentation of an
individuals medical history that is maintained
by health care providers or health institutions.
It includes information on patients
demographics progress notes, medication
problems, vital signs, past history, diagnostic
results and vaccination.
Benefits of HER
1. 1. Medical errors
EHR enables patients safety by eliminating medical
error through illegible handwriting by physicians.
Medical documentation in EHR appears to be clear
and legible and thus reduces legal implications. Fewer
forms to fill out during a visit
Fewer repetitive questions regarding past medical
history
alert system ensure proper dosage and drugs are
administered.
2. Improves patients quality of life
EHR assist in better disease management and
client education.
It also enhances communication among
healthcare providers.
When patient are educated and healthcare
providers work collaboratively better patient
outcome is achieved.
3. Reduces cost of healthcare
EHR reduces transcription, re-filling and
storage cost. It saves time and cost through
eliminating redundant diagnostic testing, paper
charting and decreasing storage and retrieval
cost. This digital format enables healthcare
professionals to communicate and track data
for specific patients
3. EHR maintains patient privacy
HIPAA law protects:
any information that your doctors, nurses, or
other health care providers put in the medical
record
conversations between doctors and others
about your familys care or treatment
information about your family in the health
insurance carriers computer system
billing information


Who has access to information?
Access to information is done through hospital
database that can be access through every
computer.
To open a patients health record, health care
providers would log into the system with a
username and password or thumbprint
identification.




History of Electronic
HealthRecords(EHR)



TIMELINE:
Mid 1960s Late 1960s 1972 19821965 Early
1970s Early 1980sLate 1980s 1994 1996 1999
2002Early 1990s 1995 1997 Early 2000s2004
2007 2009 20112006 2008 2010 Mid-2011


Mid 1960s: Lockheed Unveils ClinicalData
Management System
One of the earliest data processingsystems
focused specifically onmanaging clinical data
now called a hospital information system
(HIS).
HIS is introduced at El Camino Hospital in
Mountain View, California
1965: National Library of Medicine Moves to
Computer System
The National Library of Medicine converts
the Index Medicus a comprehensive index of
the worlds leading biomedical literature to
the computer-based version later called
Medline, beginning the shift to electronic rather
than paper-based information resources
Late 1960s: Problem-Oriented
MedicalRecord Introduced
Physician Larry Weed introduces the idea of
recording patient information electronically,
aiming to generate a record that would allow a
third party to independently verify the
diagnosis.
Prior to this, a doctor only recorded his
diagnoses and the treatment provided
Early 1970s: VistA Initiated to Manage
Veterans Health Data
The predecessor to todays Agency for
Healthcare Research and Quality(AHRQ)
initiates the concept behind Veterans Health
Information Systems and Technology
Architecture (VistA).
This marks the start of heavy government
investments in VisTA and clinical IT
1972: First Electronic Medical Records System
Developed
The Regenstreif Institute develops the first
electronic medical record system.
Although the technology is widely regarded
as a major advancement for medical practices,
it does not attract many physicians
Early 1980s: VA Health Information Software
Declared Public
The VistA information system is legally
declared available for unrestricted use within
the public or private sectors.
This open-source collaboration marks the
evolution of VA health software. Major
hospitals in other countries adopt and modify
VistA and its information-driven care model
1982: Dragon Systems Pioneers
VoiceDictation Software
Early voice recognition prototype evolves
into Dragon Dictation, used today by more
than 150,000doctors and caregivers.
Its wide adoption illustrates that one early
key to success in healthcare IT was a design
built around doctors existing processes
Late 1980s: Emergence of Low-Cost
PCsSpurs Wide Adoption
Lower costs of personal computers(PCs)
make it an affordable way to automate core
health care functions. Windows-based
software emerge soon thereafter. Doctors
follow the trend and buy PCs for their offices.
While EHRs werent widely adopted yet,
practice management functions (billing and
scheduling)started to move to computers
Early 1990s: Emergence of the WorldWide
Web
After Tim Berners-Lee established the World
WideWeb in 1990, new developments in
browser interfaces such as Microsoft
Explorer and Netscape Navigator make it
faster and easier to access information online.
People begin to access health information
online and the stage is set for web-based
EHRs
1994: Clinitec Sells Software to ConvertPaper
Records to EHRs
Two years after its birth the company is
bought by Quality Systems, Inc., a dental
software company, which soon merges with
Micromed, which provides front- and back-
office practice management software.
In 2001, Clinitec and Micromed combine to
form NextGen Healthcare Information
Systems, which becomesNextGen Healthcare.
1995: Eclypsis Corporation Founded
The company provides hospitals and other
healthcare organizations with EMR,
computerized physician order entry, and
revenue cycle management software.
In 2008, the company acquires physician
practice management software company
MediNotes.
Eclypsis merged with All scripts in August
2010.
1996: Health Insurance Portability and
Accountability Act
All software used to manage health
insurance claims must follow HIPAAs new
regulations on health record use, disclosure
and confidentiality.
Software developers accurately predict one
consequence of HIPAA will be a shift to
electronic health record (EHR),which can
greatly aid providers in complying with
confidentiality laws.
Veterans Health Administration Mandates Use
of EHRs
The largest integrated health care system in
the United States, VHA, mandates use of
EHRs throughout all facilities. VHA quality of
care shows significant improvement in the
wake of these changes.
Later research indicates VHA care is better
than that administered by Medicare, the
government social insurance program
administeredto Americans 65 and older.
1997: Allscripts Begins Focusing onHealthcare
IT
The company a year later launches an
electronic prescribing solution for physicians,
then acquires a series of ambulatory electronic
medical record companies.
By 2011 the product is used by over180,000
physicians. Allscripts is now arguably the
largest EHR vendor
1999: eClinical Works Started by Four
Engineers and a Physician
The company quickly becomes a market
leader in ambulatory HER systems, eventually
partnering with Sams Club and Dell to sell the
brands EHR and practice management
software as turn key solutions for small
practices.
Early 2000s: Emergence of Web-based
Software
Salesforce.com and other web-based
companies emerge, proving that the software-
as-a-service(SaaS) model is viable.
EHR vendors begin to offer remotely-hosted
options, and new purely web-based vendors
start to enter the market.
2002: GE Acquires MedicaLogic andMillbrook
The acquired solutions are later re-branded
Centricity with two applications, Centricity
EMR and Centricity Physician Office.
Building on the momentum and experience
of MediaLogic and Millbrook, Centricity
eventually emerges as the brand of 31
healthcare IT solutions that form part of GE
Healthcare, a division of General Electric
valued at $17 billion today.
2004: President George W. BushPromotes
Adoption of EHRs
Demonstrating his commitment to
healthcare information technology, the
President for health care IT demonstration
projects to$100 million, creates a new sub-
Cabinet position of National Health Information
Coordinator, and calls for widespread adoption
of EHRs by 2014, referring specifically to
standards for electronically transmitting X-rays,
lab results and electronic prescriptions. EHRs
gain momentum.
2006: CCHIT Certifies Electronic Health
Records Systems
Certification Commission for Health
Information Technology(CCHIT), a nonprofit
aiming to accelerate adoption of secure and
interoperable health IT, begins certifying
electronic health records systems to help
providers choose quality products.
Controversy emerges later over CCHITs close
ties to the board of trustees ofHealth care
Information and Management Systems
Society(HIMSS)
2007: VA and Kaiser Permanente Create
CONNECT
CONNECT- an open-source, cross-agency
software system promotes sharing health
recordsand aims to move the US toward
national interoperability. Health giant Kaiser
Permanente achieves inter operability with
VistA and uses many of its techniques
2008: Idea of Personal Health Record Re
emerges
Growth in the Internet drives the idea of the
personal health record (PHR), a record where
an individual curates his/her own health data
online or via an electronic device.
With the development of web technologies,
the possibility of storing, exporting, and
sharing patient-reported data makes sense.
Google and Microsoft release PHR solutions
2009: HITECH Act Passes
Health Information Technology for Economic
and Clinical Health(HITECH) Act passes as
part of President Obamas American Recovery
and Reinvestment Act (ARRA) of 2009stimulus
package. ARRA encourages the switch to
electronic records by providing Medicaid
rebates of up to$63,750 and Medicare rebates
of up to $44,000
2010: Apples iPad Spurs Widespread Use of
Tablet Computers
The iPad ushers in the reemergence of the
tablet era to build on the features of the earlier
Tablet PC. Experts predict Gen Y and Zers will
be eager to engage with personal medical
records in part because of the high-tech,
interactive format.
Physicians start to demand the same
simplicity and convenience in the workplace
that they enjoy at home with their iPads.
2011: ONC-ATCB Certification Program
Created
The Office of the National Coordinator of the
HITECH Act creates a certification program in
response to the need for clarity on what EHRs
are capable of meeting meaningful use criteria
during the first phase, or Stage 1, of adopting
EHRs. Specifically, the ONC announces which
that 6 certification bodies, including CCHIT,
are approved to verify meaningful use.
Mid-2011: HHS Proposes Accountable Care
To help providers better coordinate care
across settings for Medicare patients, new
regulations propose creating Accountable
Care Organizations. ACOs that help reduce
healthcare costs and meet performance
standards would be rewarded. This
represents a shift away from fee-for-service
model toward a focus on prevention with the
HER playing a key role in capturing patient
data for sharing within an ACO.