Introduction to

Nursing Informatics
 Course Description: This course deals with
use of information technology system and data
standards based on nursing informatics
principles/theories. It further deals with the
utilization of clinical information systems in the
management and decision making of patient
care. A laboratory session shall be provided for
practice application.
 Course Credit: 2 units lecture, 1 unit
laboratory
 Contact Hours / Semester: 36 hours lecture,
54 hours laboratory
 Placement: 2nd year, Summer
 Course Objectives: At the end of the
course and given relevant actual or
simulated situation or conditions, the
student will be able to:
◦ Apply concept, theories, and principles of
informatics in nursing and health care.
◦ Discuss issues and trends in informatics relevant
to nursing and health.
Topic outline

1. Computers and Nursing

2. Historical Perspective of Nursing and
Computer
3. Electronic Health Record from a Historical
Perspective

 Laboratory:
1. Flowchart of History of Nursing,
Informatics, and Nursing Informatics
Building blocks
 Basic element or part of nursing
informatics such as:
1. Information science
2. Computer science
3. Cognitive science
4. Nursing science
Computer Science
 Branch of engineering (application
of science) that studies the
theoretical foundations of
information and computation and
their implementation and
application in computer systems

 Study of storage/memory,
conversion and transformation,
Information Science
 Study of the application and usage
of information and knowledge in
organizations and the interfacings
or interaction between people,
organizations and information
systems.

 It is an extensive, interdisciplinary
science that integrates features
from cognitive science,
communication science, computer
science, library science and social
sciences.
Cognitive Science
 An interdisciplinary field that studies
the mind, intelligence and behavior
from an information processing
perspective.
Nursing science
 The ethical application of
knowledge acquired through
education, research and practice
to provide services and
interventions to patients in
order to maintain, enhance or
restore their health; to advocate
for health, and to acquire,
process, generate and
disseminate nursing knowledge
to advance the nursing
profession.
Nursing Informatics (cont)
 A specialty that integrates nursing
science, computer science,
cognitive science, and information
science to manage and
communicate data, information,
knowledge and wisdom 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.
 Major Historical
Perspectives of Nursing
and Computers
Computer technology
1. Six time periods: before 1960s, 1970s,
1980s, 1990s and post 2000
2. Four major nursing areas: nursing
practice, administration, education and
research
3. Standards initiatives: nursing practice,
nursing data and health care data
standards
4. Significant event landmark: milestone
chart
Prior to the 1960s
 Few experts use computers
 Nursing profession was undergoing major

changes
 Nursing practices and services was

expanding in scope and complexity

 Computers were initially used for office

functions
 Punch cards and card readers
 Teletypewriters and paper tapes
1960s
 “Why computers”
 “What should be computerized?”
 Introduction of cathode ray tube (CRT)

terminals, online data communications

 Hospital information systems (HIS)– billing

and accounting dept

1970s
 Nurses began to recognize the value of
computers
 Aside from HIS, computer-based

management information system (MIS) was

developed by diff health agencies
 Third party payers- Medicare patient

services on billing and financial info

1980s
 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
1990s
 IT and informatics were promoted in health
care esp. nursing field
 1992 – NI was approved by ANA as a new

nursing specialty
 Database for nursing vocabularies,

taxonomies, classification schemes were

developed
 Laptops, notebooks
 Workstation and LAN were developed for

hospital nursing units

1990s
 Internet brought new cyberspace forming
building blocks for sophisticated IT
 1995 – e-mail, file transfer protocol

(FTP),www protocols
 High performance computing and

communication (HPCC)
Post 2000
 Individualized electronic patient record
(EPR) and EHR
 Wireless tablet computers, personal digital

assistants, cellphones, voice over internet

protocols were developed to enhance
healthcare facilities
 telenursing
Post 2000
 Health Insurance Portability and
Accountability Act of 1996 (HIPAA) was
enacted to streamline health care
transactions
 2004 – protect the security, ensure privacy

and confidentiality was implemented

y2k
 The origin of the Year 2000 problem began with these cards
(Randall, 1997). They were limited in the data they could
store by the number of columns. To save space they decided
to omit the century. Punch card technology was not
widespread in 1900 so this omission caused few problems.
Because this system worked well and storage was still
expensive (even through the early 1990's), serious efforts
were not made to rectify this until about 1995. The difficulty
occurred because computers were not be able to distinguish
between the year 2001 and 1901. This may not seem like a
problem until one realizes that computers do "date
arithmetic," that is they can subtract or add a given number
of days from dates, or determine the number of days
between dates.

Nursing Informatics
Its Origin
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 Sackett & Erdley).
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
first used and defined by Scholes and Barber in
1980 in their address to the MEDINFO
conference that year in Tokyo.
 Health-care Informatics, however, is truly
interdisciplinary. In its truest form it focuses on
the care of the patient, not a specific discipline.
Thus, although there are specific bodies of
knowledge for each health care profession,
nursing, dentistry, dietetics, pharmacy,
medicine, etc., they interface at the patient.
Hannah 1985

 "The use of information technology in

relation to any of the functions which are
within the purview of nursing and which are
carried out by nurses. Hence, any use of
information technology by nurses in relation
to the care of patients, or the educational
preparation of individuals to practice in the
discipline is considered nursing
informatics." (P. 181)
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; design, 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 specialty
· Formal representing organizations include the American Medical
Informatics Association (AMIA) and International Medical Informatics
Association (IMIA)
· Defined research priorities seek a standardized language
· Differentiated practice focuses upon data information and
knowledge

Copyright ©2005 by Pearson Education,

Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara Inc.
Handbook of Informatics for Nurses & Health Care Upper Saddle River, New Jersey 07458
Professionals, 3e All rights reserved.
Saba & McCormick 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." (p. 222)
 "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.
◦ Apply educational resources to nursing education." (p. 226)
Nursing informatics
 A specialty that integrates nursing science,
computer science, cognitive science, and
information science to manage and
communicate data, information, knowledge
and wisdom in nursing practice; Nursing
informatics facilitates the integration of
data, information, and knowledge to
support patients, nurses, and other
providers in their decision-making in all
roles and settings.
Nursing
 The American Nurses’ Association (2003)
 “Nursing is the protection, promotion, and
optimization of health and abilities,
prevention of illness and injury, alleviation of
suffering through the diagnosis and treatment
of human response, and advocacy in the care
of individuals, families, communities, and
populations.”
 Thus the focus of nursing is on the human
responses to actual or potential health
problems, and advocacy for various clients.
 Nurses must possess the technical skills to manage
equipment and perform procedures, interpersonal
skills to interact appropriately with people, and
cognitive skills to observe, recognize and collect
data, analyze and interpret data and reach a
reasonable conclusion that forms the basis of a
decision.
 Nursing is an information intensive profession.
 The steps of utilizing information, applying
knowledge to a problem, and acting with wisdom
form the basis of nursing practice science. We
acquire data and information in bits and pieces and
then transform the information into knowledge.
Knowledge
 The awareness and understanding of a set
of information and ways that information
can be made useful to support a specific
task or arrive at a decision; abounds with
others’ thoughts and information;
information that is synthesized so that
relationships are identified and formalized;
Nursing and Knowledge

 Nurses are knowledge workers, working

with information and generating information
and knowledge as a product.
 We are knowledge acquirers, providing

convenient and efficient means of capturing

and storing knowledge.
 We are knowledge users, individuals or

groups who benefit from valuable, viable

knowledge.
Nursing in the Future

 The future of nursing science and nursing informatics is

intimately associated with the nursing education and
nursing research arenas.
 Skiba (2007) suggests that we need techno-saavy and well-
informed faculty who can demonstrate the appropriate use
of technologies to enhance the delivery of nursing care.
 Goosen (2002) believes that the focus on nursing
informatics research should be on the structuring and
processing of patient information and how these inform
nursing decision making in clinical practice.
 It is clear that the increasing use of technology to enhance
nursing practice, nursing education, and nursing research
will open new avenues for acquiring, processing,
generating, and disseminating knowledge.
Importance of NI
 The use of artificial intelligence or decision-making
systems to support the use of the nursing process
 The use of a computer-based scheduling package
to allocate staff in a hospital or health care
organization
 The use of computers for patient education
 The use of computer-assisted learning in nursing
education
 Nursing use of a hospital information system
 Research related to information nurses use in
making patient care decisions and how those
decisions are made
Importance of NI
 Administer nursing services and resources
 Manage delivery of patient and nursing care
including documentation and planning
 Link research resources & findings to nursing
practice.
 Apply educational resources to nursing education.
 administer nursing services and resources
 Manage delivery of patient and nursing care
including documentation and planning
 Link research resources & findings to nursing
practice.
 Apply educational resources to nursing education."
.
 "Nursing informatics is the multi-disciplinary
scientific endeavor of analyzing, formalizing
and modeling how nurses collect and
manage data, process data into information
and knowledge, makes knowledge-based
decisions and inferences for patient care,
and uses this empirical and experiential
knowledge in order to broaden the scope
and enhance the quality of their
professional practice.
The Electronic Health Record (EHR)
Electronic Health Record (EHR)
 Is a longitudinal electronic record of patient
health information generated by one or more
encounters in any care delivery setting.
◦ patient demographics
◦ progress notes
◦ Problems
◦ Medications
◦ vital signs
◦ past medical history
◦ Immunizations
◦ laboratory data
◦ radiology reports
The EHR automates and streamlines the
clinician's workflow. The EHR has the ability
to generate a complete record of a clinical
patient encounter, as well as supporting
other care-related activities directly or
indirectly via interface—including evidence-
based decision support, quality
management, and outcomes reporting.”
 The Health Information Management

Systems Society’s (HIMSS)

History of EHRs

 The first known medical record was

developed by Hippocrates, in the fifth
century B.C.
◦ He prescribed two goals:
◦ A medical record should accurately reflect the
course of disease.
◦ A medical record should indicate the probable
cause of disease.
Electronic health record (EHR):
“secure, real-time, point of care,
patient-centric information resource
for clinicians (HIMMS)
· Provides access to the patient
health record information at the
time and place the clinicians need
it
· Evidenced based decision
support .
 Computer-based patient record (CPR):
lifetime patient record that includes all
information from all specialties
· Problem list
· Health status and functional levels
· Clinical reasoning for diagnoses and
conclusions
· Lifetime patient record
· Supports confidentiality

Copyright ©2005 by Pearson Education,

Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara Inc.
Handbook of Informatics for Nurses & Health Care Upper Saddle River, New Jersey 07458
Professionals, 3e All rights reserved.
 More CPR
· Continuous access
· Views of client data
· Links to local and remote information resources
· Facilitates clinical problem solving
· Data entry
· Measures cost and quality of care
· Flexible and expandable

Copyright ©2005 by Pearson Education,

Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara Inc.
Handbook of Informatics for Nurses & Health Care Upper Saddle River, New Jersey 07458
Professionals, 3e All rights reserved.
 Figure 12-1: A Sample of EHR components
Copyright ©2005 by Pearson Education,
Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara Inc.
Handbook of Informatics for Nurses & Health Care Upper Saddle River, New Jersey 07458
Professionals, 3e All rights reserved.
 Figure 12-1: A Sample of EHR components
Copyright ©2005 by Pearson Education,
Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara Inc.
Handbook of Informatics for Nurses & Health Care Upper Saddle River, New Jersey 07458
Professionals, 3e All rights reserved.
 Benefits of EHR
· Improved data integrity
· Increased productivity
· Improved quality of care
· Increased caregiver
satisfaction

Copyright ©2005 by Pearson Education,

Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara Inc.
Handbook of Informatics for Nurses & Health Care Upper Saddle River, New Jersey 07458
Professionals, 3e All rights reserved.
 Concerns to be resolved before
implementing EHR
· Electronic infrastructure must be
agreed upon by all stakeholders
· Cost
· Vocabulary standardization
· Security and confidentiality
· Caregiver resistance
· Data integrity
Copyright ©2005 by Pearson Education,
Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara Inc.
Handbook of Informatics for Nurses & Health Care Upper Saddle River, New Jersey 07458
Professionals, 3e All rights reserved.
Nursing informatics is a specialty that
integrates nursing science, computer science,
and information science to manage and
communicate data, information,knowledge,
and wisdom in nursing practice. Nursing
informatics facilitates the integration of data,
information, knowledge, and wisdom to
support patients, nurses, and other providers
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 (2008). Nursing informatics:
Scope and standards of practice, Silver Springs, MD, American
Nurses Association. p.65.
“Computers are a tool and only a
tool…”

“Information technology in
healthcare is the means to
transformation, not the end goal”

END