Informatics, What is it?

1966 “Informatika” Sackett and erdley (2002), a Russian Scientist in 1966 coined the term informatika and defined it as “The discipline of science which investigates the structures and properties (not specific content) of scientific information..” (Collen as cited in sackettt & Elderly).

1970 “Informatique” A frenchman, in the 1970’s, Francois Gremy is credited with coining the term informatique medical, translated to medical informatics It was defined as the informational technologies which are concerned with patient care and the medical decision making process. Another definition stated that medical informatics is the complex data processing by the computer to create new information.

1980 “Nursing Informatics” The term “nursing informatics”, was probably used and defined by Scholes and Barber in 1980 in their address to the MEDINFO conference that year in Tokyo.Health- care informatics, howerver, is truly interdisciplinary. In its truest form it focuses on the care of patient, not a specific discipline. Thus although there are specific bodies of knowledge for ech health care profession, nursing, dentistry, dietetics, pharmacy, medicine, etc.. They interface at the patient.

Evolution of Nursing Informatics

Prior to the 1960’s

Few experts use computersNursing profession was undergoing major changesNursing practices and services was expanding in scope and complexityComputers were initially used for office functionsPunch card and card readersTeletypewriters and paper tapes.Hospital information system (HIS)- billing and accounting dept

1970’s Nurses began to recognize the value of computersAside from HIS, computer-based management information system (MIS) was developed by diff health agenciesThird party payers- Medicare patient services on billing and financial info.

1980’s NI became an accepted specialty and many nursing experts entered the field.Computer-based patient record systems (CPRS)Kardex, reporting of results, VS.Discharge planning system was developed for community health care facilities in the continuum care

1990’s

IT and informatics were promoted in health care esp. Nursing field1992- NI was approved by ANA as a new nursing specialtyDatabase for nursing vocabularies, taxonomies, classification schemes were developedLaptops, notebooksWorkstation and LAN were developed for hospital nursing unitsInternet brought new cyberspace forming building blocks for sophisticated IT1995- e-mail, file transfer protocol (FTP), www protocolsHigh performance computing and communication (HPCC)

ANA Council on Computer Applications in Nursing 1992“... 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; designs, implement and evaluate information systems and data structures that support nursing: and identify and apply computer technologies for nursing.”

Nursing informatics: recognized by the ANA as a specialty in 1992 Scope and standards of nursing informatics practice offers guidelines for the specialist Certification examination offered by ANCC Formal education programs prepare the RN for entry into nursing informatics specialtyFormal representing organizations include the American Mediacal informatics Association (AMIA) and International Medical Informatics Association (MIA)Defined research priorities seek a standard languageDifferentiate practice focuses upon data informatiom and knowledge

Saba & Mc Cormick 1995 “It is concerned with the legitimate access to and use of data, information, and knowledge to standardize documentation, improve communication, and support decision-making process.” “ The use of technology and/or a computer system to collect, store, process, display, retrieve, and communicate timely data and information in and across health care facilities that: Administer nursing services and resources, manage the delivery of patient and nursing care, link research resources and findings to nursing practice and apply educational resources to nursing education.

Post 2000 Individualized electronic patient record (EPR) and EHRWireless tablet computers, personal digital assistants, cellphones, voice over internet protocols were developed to enhance health care facilities.TelenursingHealth Insurance Portability and accountability act of 1996 (HIPAA) was enacted to streamline health care transactions2004- protect the security, ensure privacy and confidentiality was implemented.

Past Nursing Informatics

Nursing informatics was first defined as the use of computer technology to support nursing, including clinical practice, administration, education and research.

The first generation of nursing information systems was designed to speed paperwork and communication. In general, the systems accomplished this by transferring information to the computer, what nurses had done on paper and by telephone. These systems replaced paper records, filing cabinets and pneumatic tubes. Although this was helpful and effective in reducing the time spent on documentation and communication it did not address many of the fundamental issues for nurses’ use of data, information and knowledge to guide effective care (Executive summary, 2004).

Until 1948, primary care remained in the home. With the development of Hill-Burton Act of 1948, money was provided for the building of hospitals and promoted a catalyst for change in healthcare. In the 1960’s, Medicare and Medicaid provided reimbursement for services to many individual patients and the health insurance industry grew. This provision of funding allowed many new innovations: new drugs, advanced surgical procedures, new technologies and equipment, and sophisticated diagnostic procedures. All of which led to the development of medical specialties, each treating a different part of the patient and creating its own records for what patient (Thede, 2003).

Present Nursing Informatics

Although the history of nursing informatics extends only some twenty years, the field is advancing rapidly as a scientific discipline and has significant implications for patient care (Executive Summary, 2004).

As research in nursing informatics evolves, it has become apparent that the issues are far more complex than reducing time spent on paper work. The high-intensity generation, management, processing of data and knowledge are integral components of nursing care. Informatics gives nurses the means to carry out these aspects of care efficiently and effectively to improve outcomes for patients.

Nursing informatics impacts nurses today. Today, evolving standards of practice increase the nurse’s accountability. The malpractice crisis has strengthened accountability and increased emphasis on complete and detailed nursing documentation. Changes in reimbursement methods are affecting nursing care delivery. Cost containment and consumerism place additional pressures on not only the individual nurse but also the entire nursing profession (Ball, et al. 2000).

Role of the Nurse as knowledge worker

lHealth care settings are knowledge intensive

lExponential growth in knowledge

lInformation technology supports evidence -based practice through just-in-time access to information

lNurses detect patterns to create new knowledge

lData gatherer Collects clinical data lInformation user Interprets clinical data and uses it to monitor pati, aids with decisions.lKnowledge user Compares data to current knowledge lKnowledge builder Amassed data to show patterns that can be interpreted using existing knowledge or used to create new knowledge.

Knowledge worker roles

lGood information management provides the right information at the right time to the right people

lKnowledge management creates systems that enable organizations to tap into the knowledge, experiences and creativity of their staff to improve their performance

Information vs. Knowledge Management

Medical Informatics

The application of information science and technology to acquire, process, organize, interpret, store, use and communicate medical data in all of its forms in medical education, practice and research, patient care, and health management.

Hebda (1998). Defines nursing informatics as the use of computers technology to support nursing, including clinical practice, administration, education and research.

“Integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom into nursing practice… facilitates the integration of data, information, knowledge and wisdom into nursing practice. Facilitates the integration of data, information, knowledge and wisdom to support patients, nurses and other provides in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology.”(American Nurses Association)

APPLICATION OF NURSING INFORMATICS / GENERAL PURPOSE

Nursing Clinical Practice: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 (EMR).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 system)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 programmes.Internet resources- formal nursing courses and degree programmes.Presentation software for preparing slides and handouts- power points and MS words.

Patient Education:

Nursing informatics can be used for symptom management and patient education. The nurse can access the information for the patient or teach the patient where to find appropriate and helpful information. For example, on an oncology unit, nursing informatics can be used to teach patients effective symptom management of the treatment modalities which often cause pain, fatigue and poor nutritional status. Nursing informatics can also aid in other nursing interventions of the oncology nurse, such as analgesic administration and stress-reduction techniques.

Clinical Alert System:

The computerized clinical alert system can be used in conjunction with the hospital pharmacy. A system design is created to alert both pharmacy and health staff when two or more drug prescriptions are incompatible.

Consumer Informatics

Branch of medical informatics that studies the use of electronic information and communication to improve medical outcomes and the health care decisions. Making process from the patient / consumer perspective.(AMIA, May 3, 2007)

The Future:

Help the clinicians to develop needed competencies.Develop and implement information technologyGenerate new knowledgeNew roles with consumersNew technology-genomonics, wearable monitoring devices, development in educational technology.

Nursing informatics has arrived and the baby has started to walk. In the process, nursing informatics has introduced new challenges and opportunities along with new computer applications.

Nursing informatics is a growing field for advancement and offers many potential areas for cost containment.

Clients may receive treatment in their own community where services cost less, improving quality of care and improved continuity of care through convenient follow-up.