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NURSING INFORMATICS
CONCEPTS, PRINCIPLES, AND THEORIES
IN NURSING INFORMATICS
Computer in Healthcare Healthcare information technology all encompassing terms referring to technology that captures, processes, and generates healthcare information. ● provision and documentation of patient care ● education of healthcare providers ● scientific research for advancing healthcare delivery ● administration of healthcare delivery service ● reimbursement patient care ● legal and ethical implications ● safety and quality issues
INFORMATICS
- applied computer science concerned with the processing of information
- the use of information technologies in relation to any nursing functions and actions(Katherine Hannah, 1985)
- nursing informatics is a combination of computer science, information science, and nursing science designed to assist in the management and processing of nursing data, information, and knowledge to support the practice of nursing and the delivery of nursing care (Graves & Corcoran, 1989)
Why is there a need for Nursing INFORMATICS? Good decisions require accurate and accessible data as well. At the start of nursing informatics, is the goal of providing nurses with data, information, and support for information processing to make effective decisions.
Informatics Nurse
- a registered nurse (RN) who has experience in nursing informatics
Information Nurse Specialist
- a graduate level prepared specialty nurse
- needs specialty course
THEORIES SUPPORTING NURSING INFORMATICS
Nursing Theories
- are about nursing practice - a nurse’s interactions or relationships with individuals, groups, or communities (also known as patients or clients) focused on applying the nursing process
- any nursing theory might be useful for an informatics nurse, since informatics nurses work with individuals, groups, and communities
Computer Science
- is the study of algorithms for solving computation problems
- if an algorithm can be identified for solving a particular problem, an automated solution to the problem can be developed
- provides the foundational knowledge and skills needed to manage and utilize healthcare data effectively
- includes understanding how to work with electronic health records, analyze data for improved patient care, and develop new technologies to support nursing practice
Information Science
- focuses on gathering, manipulation, classification, storage, and retrieval of recorded knowledge
- can be socially oriented, focused on humans and machines, and closely linked to communications and human behavior
- tries to understand problems from the perspective of the stakeholders and applies information and technology as needed to solve the problems
- the three important branches of information science are: (1) information , (2) retrieval , (3) human-computer interactions - from the perspective of knowledge manipulation, and information handling within a system (human or machine)
- crucial to nursing informatics as it provides the theoretical and practical framework for managing and communicating data, information, knowledge, and wisdom in nursing practice
Communication
- communication theory uses these core concepts and additional principles developed since then to analyze
information transfer and the effectiveness and efficiency of communications
- within a communication model, Bruce I. Blum presented a taxonomy, with definitions, of the central concepts of data, information, and knowledge - these are the concepts adopted by nursing informatics - Blum identified data as discrete entities that are described objectively without interpretation; that is, the facts, without context
- wisdom = applicator knowledge = intervention information = cause (meaning of the data)
Cognitive Science
- cognitive technologies, including computers, smart phones, and web browsers, are media emerging from cognitive science that help in learning, memory, problem solving, and living daily life in modern society
Systems
- systems theory focuses on the organization and interdependence of relationships within a system
- the basic model of a system is one of inputs crossing the boundary, processing of the input through the system (throughput), and the emergence through the system boundary of some kind of output
- input > system (analyzes) > output
MODEL FOR NURSING INFORMATICS
The foundations of nursing informatics are the models and core phenomena.
The core phenomena are: data , information , knowledge , and wisdom and the transformations that each of these undergo.
CLINICAL INFORMATION SYSTEM
- is to depict system components, influencing factors, and relationships that need to be considered when attempting to capture the complexities of professional nursing practice
GRAVES AND CORCORAN MODEL
- nursing informatics is a combination ofcomputer science, information science, and nursing science designed to assist in the management and processing of nursing data, information, and knowledge to support the practice of nursing and the delivery of nursing care
- nursing informatics as a linear progression - from data into information and knowledge
- management processing is integrated within each elements, depicting nursing informatics as the proper management of knowledge - from data as it is converted into information and knowledge
PATRICIA SCHWIRIAN MODEL
- a model of nursing informatics to stimulate and guide systematic research in this discipline
- nursing informatics involves identification of information needs, resolution of the needs, and attainment of nursing goals or objectives
- made because there is sparse knowledge or information
- model or framework that enables identification of significant information needs that can foster research (somewhat similar to Maslow’s hierarchy of needs)
TURLEY MODEL
- in 1996, proposed another model in which the core components of informatics (cognitive science,information science, and computer science) are depicted as intersecting circles
- nursing informatics is the interaction between the discipline-specific science (nursing) and the areas of informatics
- the intersection of nursing science and informatics
- four core components: 1. nursing science 2. computer science 3. information science 4. cognitive science
FOUNDATION OF KNOWLEDGE MODEL
- is a theoretical framework that describe the process of how knowledge is acquired, processed, generated, and disseminated
- proposed by Dee McGonigle and Kathleen Mastrian in 2012
- Programming Environment Support Programs
- are used by program developers to support their programming work or to run their programs
Application Software
- includes all the various programs people use to do work, process data, play games, communicate with others, and watch videos and multimedia programs on a computer
APPLICATION OF HEALTH INFORMATICS
ELECTRONIC HEALTH RECORDS
- longitudinal electronic record of the patient health information generated by one or more encounters in any care delivery setting
- as multiple departments work in concert for optimum and safe patient care delivery, the components of an HER integrate data in a coordinated fashion to provide an organization, administration, and clinicians demographic, financial, and clinical information
EHEALTH
- is an emerging field of medical informatics referring to the organization and delivery of health services and information using the web and related technologies
- EHEALTH technologies provide opportunities for customized and meaningful communication enabling patients to receive individually tailored information
- can empower consumers and patients, and it opens doors for new types of relationships, such as shared decision-making between a patient and his / her healthcare providers
TELEMEDICINE
- the use of information exchanged from one site to another via electronic communication to improve patient health status
- closely associated with telemedicine, is the TELEHEALTH which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services
TELEHEALTH
- can be considered another component of health concept,
with the difference being around the delivery mechanisms, which can include live video conferencing, store- and forward systems, such as those used to store distal images; telephone conferencing; and remote patient monitoring and e- visits via a secure web portal
INFORMATION TECHNOLOGY SYSTEM
APPLICABLE IN NURSING PRACTICE
OPEN SOURCE AND FREE SOFTWARE (OSS/FS)
Competition and Innovation It is suggested that in healthcare, as in many other areas, the development of OSS / FS may provide much-needed competition to the relatively closed market of commercial, proprietary software (Smith, 2002), and thus encourage innovation.
Cost and Quality Benefits This could lead to lower cost and higher quality systems that are more responsive to changing clinical needs and offers higher quality solutions.
Problems with Current Health Information Systems (HISs) ● lack of interoperability between systems ● vendor lock-in limits flexibility ● high maintenance costs and data management issues ● security, privacy, and consent concerns ● rapid changes and large-scale information demands pose challenges
Advantages of OSS / FS ● OSS/FS adheres more closely to industry standards ● open-source code allows inspection, customization, and adaptation ● promotes transparency and collaboration
Interoperability Requires Open Standards ● interoperability of HISs depends on consistent implementation of open standards ● OSS/FS supports and encourages the use of open standards
What are Open Standards?
- as described by the International Telecommunications Union (ITU) , are made available to the general public and developed, approved, and maintained via a collaborative and consensus-driven process
- a key element of the process is that, by being open, there is less risk of being dominated by any single interest group
Benefits of Openness ● reduces the risk of domination by a single vendor or interest group ● ensures fairness, neutrality, and broader stakeholder involvement
OSS / FS Advantages Over Proprietary Software
- ease of modification and customization
- large, active developer community
- stronger compliance with open standards
- enhanced security
- source code available if vendor fails
- ideal for education and research
- cost-effective for smaller health providers (e.g., clinics, home care)
Problems with Proprietary EHR Systems
- expensive and inflexible
- hard to maintain and update
- poor interoperability
- often no better than paper systems
- lead to clinician resistance
Why is OSS / FS promising for EHR? ● proven success in information-intensive industries ● potential to integrate functional, interoperable EHRs ● global examples of success ● seen as a way to improve U.S. healthcare systems
Currently, there is much interest in interoperability testing of systems, not only between proprietary systems, but also among OSS/FS systems, and between OSS/FS systems and proprietary systems.
Integrating the Healthcare Enterprise (IHE) has developed a range of open source interoperability testing tools, called MESA , KUDU , and its next generation tool GAZELLE , to test healthcare interoperability according to the standards profiled by the IHE in its technical frameworks.
Certification Commission for Health Information Technology (CCHIT)
- has developed an open source program called Laika to test EHR software for compliance with CCHIT (CCHIT, n.d.) interoperability standards
Limitations and Challenges of OSS / FS ● need for IT training and support ● often underfunded (affects updates and stability) ● historically excluded from certification (until 2009) ● perceived as "lesser" solutions ● other issues: ○ limited documentation ○ language barriers (e.g., english-only resources) ○ resistance to change by staff ○ unclear ROI and slower adoption
Notable Open Source EHR Projects ● VistA : Most developed and widely used OSS EHR ● others with over 15 years of development ● many offer demo versions online
Types of OSS / FS Systems in Healthcare
- Electronic Medical Records (EMRs)
- Hospital Management Systems
- Laboratory Information Systems (LIS)
- Radiology and Imaging Systems
- Telemedicine Platforms
- Practice Management Systems
- Picture Archiving and Communication Systems (PACS)
ClearHealth(www.clear-health.com)
- web-based platform for practices of all sizes, includes scheduling and registration tools
- EMR features: ● alerts ● patient dashboard ● laboratory ordering and results ● barcode generation and usage
- supports SNOMED terminology
- accessible via mobile devices
- billing and reporting functionality
- specialist clinical modules available
Indivo(indivohealth.org)
- original personal health platform
- empowers individuals to own and manage a secure, digital copy of their health and wellness data
- integrates health information across care sites and over time
- free, open source, and uses open, unencumbered standards (e.g., SMART Platforms)
eHEALTH APPLICATIONS
NON-CLINICAL
APPLICATIONS CLINICAL APPLICATIONS
● professional education ● healthcare administration ● research ● aggregated health data analysis ● excludes direct patient treatment or decisions
● direct medical decision-making ● diagnosis and treatment ● includes data like emails between patients and providers stored in health records
Clinical Applications of Telemedicine
- can be delivered at the point of service or remotely
- used in:
- home-based care (home-bound or rural patients)
- correctional facilities
- acute care facilities (e.g., ICU remote monitoring)
The Impact of Telehealth on Healthcare Delivery
- supports specialized services: - telepathology - telepsychology - ICU remote monitoring
- enables new provider-patient relationships
- shifts healthcare from a physician-centric model to a more consumer-empowered system
- promotes modern, accessible, and patient-centered care
Consumer Engagement The National eHealth Collaborative (2012) developed the Patient Engagement Framework to assist healthcare organizations in developing a strategic plan to incorporate eHealth tools and resources as part of an overall engagement strategy.
Table 22.1 The Patient Engagement Framework
(National eHealth Collaborative, 2012)
Phase Description
Inform Me The focus is on providing information to assist
patients in obtaining relevant materials. Examples include use of mobile devices for directory services, access to basic health information for wellness and prevention, electronic access to standard forms (HIPAA, insurance forms, etc.), and specific information about tests, medications, and procedures.
Engage Me
The focus is on providing patients with specific information concerning their care needs. Examples include electronic tools to facilitate tracking of health and fitness behaviors, online tools to schedule appointments, and access to the electronic health record.
Empower Me
The focus is on enhancing patient involvement in the care process. Examples include secure messaging and virtual coaching. In addition, patients could have the capability of generating their own data for the health record.
Partner with Me
The focus is on tools for shared decision making and coordination of care across sites. Examples include home monitoring devices and specific directives for patient preferences and intolerances.
Support my E-Community
The focus is on enhanced information exchange. Examples include online e-community support forums and e-visits with providers.
Personal Health Records (PHR)
- PHRs are maintained by the patient, unlike medical records held by healthcare providers
- facilitate patient access to personal health and healthcare experience data
- encourage:
- tracking care encounters
- collecting and managing health information
- improved care coordination
- example: Google Health (2010)
- web-based PHR system
- features:
- build personal health profiles
- import records from hospitals / pharmacies
- share records
- explore online health services
Managing Health Conditions and Accessing Resources Electronic resources are increasingly used to manage health. Health-seeking behaviors differ for adults with chronic conditions.
Chronic condition patients are more likely to: ● search online for info on medical problems, treatments, and drugs ● consult reviews of drugs and treatments ● read/watch others' personal health experiences ● fact-check online information with clinicians ● track personal health data (e.g., symptoms, wellness metrics)
TRANSFORMING THE PRACTICE OF HEALTHCARE
Wearable and Portable Monitoring Systems
- VitalJacket (Biodevices, 2009)
- wearable T-shirt with embedded microelectronics
- continuously monitors ECG waves and heart rate
- usable for both patients and fitness/sport enthusiasts
- BodyMedia Armband (Terry, 2010)
- tracks heat flux, skin response, temperature, and movement
- data synced via USB to Activity Management Software
- supports weight loss, fitness, and wellness tracking
- Health Buddy System
- daily interface for chronic illness management
- connects to glucose meters, BP cuffs, scales, etc.
- used successfully with patients managing:
- coronary artery bypass (Zimmerman et al., 2004)
- chronic heart failure (LaFramboise et al., 2003)
- diabetes (Cherry et al., 2002)
- asthma (Guendelman et al., 2002)
- enables early alerts for worsening conditions and closes gaps in care
Telenursing
- provides care to remote or homebound patients
- reduces travel time and costs
- enhances care using videophones and visual communication
- enables personal nurse-patient connection
- facilitates better follow-up and treatment (e.g., leg wounds)
- care planning & patient education using field notes, photos, videos
Teletriage & Decision Support
- Teletriage : Remote assessment and guidance by nurses
- decision support tools guide assessment and ensure structure
- help reduce risk using clinical judgment and critical thinking
Virtual Worlds for Healthcare
- used for education and health behavior engagement (Skiba, 2007)
- users interact via avatars in 3D virtual environments
- example: CDC’s Second Life Island
- streaming health videos
- links to CDC.gov
- virtual lab and conference center
Health Portals & Web 2.
- patients use portals for:
- appointments
- prescription renewals
- reviewing test results
- example: My HealtheVet
- 24/7 access to VA health tools and records
- journals and trackers for wellness
Web 2.0 in Healthcare
- tools like Facebook, Twitter, YouTube, MySpace allow:
- peer support
- counseling
- sharing health experiences
- professional collaboration
Popular Health Platforms
- WebMD
- expert Q & A
- condition-specific topics
- peer-led groups (e.g., diet, parenting)
- PatientsLikeMe
- focus on chronic and life-changing diseases (e.g., ALS, Parkinson’s)
- forums include patients, doctors, researchers
Mobile Health (mHealth)
- mobile and wireless technologies for healthcare delivery
- enables:
- high-resolution image sharing
- live surgery streaming
- text/email/voice-based communication
- global impact of mHealth:
- reaching “bottom-of-the-pyramid” consumers
- projects in: Indonesia, Brazil, Sudan, Uganda, Tanzania, Kenya
- solar-powered phones for emergency medical care
- mHealth = essential part of eHealth in developing countries
- integration into healthcare worker training is vital
Public Health Winslow defined public health as “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals” (Winslow, 1920).
Public Health Informatics
- has been defined as “the systematic application of information and computer science and technology to public health practice, research, and learning”
- in public health informatics, population-level data and information are collected, analyzed, and disseminated with the ultimate goal of supporting preventive, as opposed to curative, interventions
Public Health Nursing
- public health nursing practice “focuses on population health through continuous surveillance and assessment of the multiple determinants of health with the intent to promote health and wellness; prevent disease, disability, and premature death; and improve neighborhood quality
Public Health Informatician (PHI)
- a public health professional who works either in practice, research, or academia and whose primary work function is to use informatics to improve population health
Nursing Informatics (NI)
- is 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 consumers, patients, nurses, and other providers in their decision-making in all roles and settings
Nurse Informatician (PHNI)
- combines the competencies of PHI and nursing informatics
- a PHNI is a PHN who has specialized in nursing informatics and has skills in supporting the establishment of systems to improve public health surveillance through access to clinical care information
THE PUBLIC HEALTH SURVEILLANCE LANDSCAPE
Public health focuses on population health rather than individual treatment.
Workers collect data on health determinants, risk factors, hazard exposure, and behaviors.
They monitor health events, deaths, and healthcare system activities to guide interventions.
Data often comes from multiple, incompatible sources, requiring integration for accuracy.
Data is collected and shared across local, state/territorial, and federal levels.
- functions:
- use patient indicators to assess care requirements
- help plan staffing and resource allocation
- support forecasting for future healthcare demand and market readiness
- Order Entry Systems
- function: automate the process of entering clinical orders (e.g., medications, labs, imaging)
- replaces: traditional handwritten physician orders
- key benefits:
- improved legibility and accuracy of orders
- enhances patient safety by reducing errors
- provides decision support (e.g., dosage checks, drug interactions)
- includes automated alerts to flag potential risks or incomplete entries
- type: commonly known as Computerized Provider Order Entry (CPOE) systems
PATIENT CARE SUPPORT SYSTEMS
Clinical Documentation Systems (CIS)
- most widely used system in healthcare
- captures real-time data at the point of care (e.g., bedside)
- used by the entire care team (nurses, physicians, pharmacists, etc.)
- records: care plans, labs, vitals, allergies, meds, interventions, outcomes
- often referred to as Electronic Health Records (EHRs)
Pharmacy Information Systems
- help pharmacists order, manage, and dispense medications
- include patient data (e.g., allergies, weight) for safe prescribing
- integrated with CIS and order entry systems
- provide decision support: interaction checking, alerts, dosage checks
Laboratory Information Systems
- among the first clinical systems adopted in healthcare
- manage and report on blood, tissue, and fluid samples
- provide test result ranges and direct clinical action via EHR integration
Radiology Information Systems (RIS) + PACS
- manage radiology workflows: scheduling, storing, and sharing results
- PACS (Picture Archiving and Communication Systems) store and display digital images (e.g., CTs, MRIs, X-rays)
- enable faster access to diagnostic images and improve accuracy
- digital access allows for instant sharing and historical comparisons
INTEROPERABILITY
- a key component to coordinated care is the interoperability of healthcare information systems
- “the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user”
DATA
- refers to raw facts that can consist of unorganized text, graphics, sound, or video
INFORMATION
- is data that have been processed—it has meaning; information is organized in a way that people find meaningful and useful
DATABASE
- is a structured or organized collection of data that is typically the main component of an information system
Department Collaboration and Exchange of Knowledge and Information
Collaboration is the sharing of ideas and experiences for the purposes of mutual understanding and learning.
Knowledge exchange is the product of collaboration when sharing an understanding of information promotes learning from past experiences to make better future decisions.
NURSING PLAN OF CARE
FRAMEWORK AND NURSING PROCESS
Nursing Plan of Care (PoC) The Nursing Process is the foundational framework for a fully operational Nursing Plan of Care (PoC). It guides registered nurses in delivering holistic, patient-centered care (ANA, 2010).
The process integrates scientific knowledge (e.g., anatomy, physiology, psychology) with nursing judgment to interpret data and make clinical decisions.
The Nursing PoC:
- acts as a clinical decision support tool
- enhances data interoperability (e.g., Clinical Care Classification - CCC System)
- improves continuity of care, care quality, efficiency, and reduces costs
- evolves as patients transition across care settings, keeping care consistent and informed
INTEGRATION OF EVIDENCE-BASED
PRACTICE AND INFORMATICS
The Steps of the Evidence-Based Practice (EBP) Process
- Cultivate a spirit of inquiry.
- Ask the burning clinical question in PICOT format.
- Search for and collect the most relevant best evidence.
- Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, and synthesis).
- Integrate the best evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change.
- Evaluate outcomes of the practice decision or change based on evidence.
- Disseminate the outcomes of the EBP decision or change.
DECISION SUPPORT AND EVIDENCE-BASED PRACTICE
Decision Support Systems (DSS)
- purpose: Assist and improve the decision-making process
- function: Leverage large volumes of data from information systems to support decisions
- use: Broadly applied across sectors, including healthcare, for informed decision-making
Clinical Decision Support Systems (CDSS)
- specialized DSS for healthcare
- supports providers in delivering and managing patient care
- benefits:
- enhances patient safety and outcomes
- promotes adherence to clinical guidelines, best practices, and regulations
Evidence-Based Adaptive CDSS
- advanced form of CDSS
- incorporates multiple rules and accesses various databases
- adaptable: continuously updates to integrate new research findings and evidence
- complex but powerful, aiming to provide the most up-to-date, accurate clinical guidance
STANDARDIZATION OF TERMINOLOGY AND DATA
Table 40.3 Examples of Nursing Classification Systems
● CC (Clinical Care Classification) ● NANDA (North American Nursing Diagnosis Association) ● NIC (Nursing Intervention Classification) ● NOC (Nursing Outcomes Classification) ● ICNP (International Classification of Nursing Practice)
Examples of medical classifications include: ● ICD-9, ICD- ● AMA CPT codes ● NDC (National Drug Classification) ● LOINC (Logical Observation Identified Names and Codes) ● SNOMED-CT (Systemized Nomenclature of Combined Terminology)
Table 40.5 (^) and Bibliographic DatabasesSources for Journals
MEDLINE I to present.ndexes over 5200 journals worldwide from 1966
CINAHL
Cumulative Index to Nursing and Allied Health Literature. Abstracts of journals, books, pamphlets, dissertations, software, and other forms of education for nursing and allied health professionals since 1982.
CRISP
Computer Retrieval of Information on Scientific Projects. A searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other research institutions that have been supported by the Department of Health and Human Services since
EMBASE
A bibliographic database which covers drug research including side effects and drug interactions.
OVID
Provides access to a variety of resources including bibliographic databases (such as MEDLINE, EMBASE, and CINAHL); full-text journals; and other clinical information products such as Evidence-Based Medicine Reviews.
The electronic health record and evidence-based practice have made great strides in the past 20 years. We are moving forward with providing evidence-based usable information at the point of care in a transparent format to not only meet regulatory, reimbursement, and government requirements, but also improve quality and outcomes and reduce costs and variations in care.
➢ Undermine the data subject’s right to privacy and informed consent, especially if the
HIPAA PRIVACY LAW
“HIPAA” is an acronym for the Health Insurance Portability & Accountability Act of 1996 (August 21), Public Law 104 – 191 , which amended the Internal Revenue Service Code of 1986.
Also known as the Kennedy-Kassebaum Act , the Act includes a section, Title II , entitled Administrative Simplification , requiring:
- improved efficiency in healthcare delivery by standardizing electronic data interchange, and
- protection of confidentiality and security of health data through setting and enforcing standards
Published new rules that will ensure:
- Standardization of electronic patient health, administrative and financial data.
- Unique health identifiers for individuals, employers, health plans and health care providers.
- Security standards protecting the confidentiality and integrity of“individually identifiable health information” past, present, or future.
Who are affected?
- virtually all healthcare organizations – including all healthcare providers, health plans, public health authorities, healthcare clearinghouses, and self insured employers – as well as life insurers, information systems vendors, various service organizations, and universities
RULES UNDER HIPPA
The Administrative Simplification is composed of four parts:
- Standards for Electronic Transactions
- Unique Identifiers Standards
- Security Rule (published on Februrary 2003; confidentiality, integrity, availability of electronic health information)
- Privacy Rule (confidentiality vs. anonymity)
INTELLECTUAL PROPERTY AND COPYRIGHT LAWS
INTELLECTUAL PROPERTY
- refers to creations of the mind, such as inventions, literary and artistic works, designs, and symbols, names, and images used in commerce
- types:
- Copyright
- Patents
- Trademarks
- Trade Secrets
- RA No. 8293 “Intellectual Property Code of the Philippines” (IP Code) - took effect in 1998 - it establishes the Intellectual Property Office of the Philippines (IPOPHL) and consolidates all major forms of IP protection in the country: patents, trademarks, industrial designs, copyright, layout-designs for integrated circuits, trade secrets, and geographic indications
COPYRIGHT LAWS
Copyright (or author’s right )
- is a legal right that protects original literary and artistic works
- it is the exclusive right of the creator of a work to distribute, sell, publish, copy, lease, or display that work in whatever manner he or she so chooses
Concepts of Copyright:
- ORIGINALITY
- own work and not copied from another person
- FIXED IN A TANGIBLE MEDIUM
- work must be fixed in an expression that is tangible, must be recorded can be conceived, communicated (when uploaded, it is tangible)
- AUTOMATIC PROTECTION
- data or personal information is kept safe without you having to do anything
Fair Use
- The purpose and character of the use, including whether such use is of commercial nature or is for nonprofit educational purposes.
- The nature of the copyrighted work.
- The amount and substantiality of the portion used in relation to the copyrighted work as a whole.
- The effect of the use upon the potential market for, or value of the copyrighted work.
PRIVACY OF PERSONAL AND PUBLIC DOMAINS
PERSONAL DOMAIN
- the domain within the organization
- this refers to information that is intended to be kept confidential and accessible only to authorized individuals
PUBLIC DOMAIN
- in the context of the internet, this broadly refers to information that is freely accessible to anyone, or to a wide, undefined audience
EHR = Personal / Private Domain
The Data Privacy Act of 2012 protects data subjects whether within personal or public domains.
NETIQUETTE RULES AND GUIDELINES
➢ Remember the human. ○ there’s a real person on the other side of the screen ➢ Adhere to the same standards of behavior onlines as you do in real life. ○ legal and ethical rules apply online just as they do offline ➢ Know where you are in cyberspace. ○ different online communities have different rooms and expectations ➢ Respect other people’s time and bandwidth. ○ be concise, get to the point, and avoid sending unnecessary or excessively large files ➢ Make yourself look good online. ○ present yourself professionally and thoughtfully
➢ Share expert knowledge. ○ if you have expertise in a topic, share it constructively ➢ Keep disagreements healthy. ○ avoid escalating arguments or engaging in personal attacks ➢ Respect other people’s privacy. ○ do not share private information about others without their consent ➢ Don’t abuse your power. ○ use that power responsibly and ethically ➢ Be forgiving of other people’s mistakes. ○ if someone makes an error, respond kindly and privately if possible
- uses social media for campaigns (H1N1, COVID, etc.), educational content, and real-time updates
Mobile Health (MHEALTH)
- defined by WHO as medical / public health practices using mobile and wireless technologies
- functions include:
- SMS, GPS, Bluetooth
- smart health monitoring devices
- apps (e.g., FDA-approved ECG, BP monitoring)
- focused mostly on wellness, exercise, and diet
- challenges: ● underutilization among older adults who have greater healthcare needs ● gap between availability and effective functionality
Benefits of Social Media The eHealth Initiative Report (2014) concluded that social media provides a multitude of benefits to patients by enabling health education and enhancing behavior by:
- breaking down the walls of patient-provider communication
- improving access to health information
- providing a new channel for peer-to-peer communications
- developing meaningful relationships
- establishing communities of patients, caregivers, and family members
- engaging and empowering people
Challenges and Concerns ● PRIVACY AND CONFIDENTIALITY
- HIPAA compliance concerns when personal health data is shared
- risk of unauthorized sharing (e.g., students posting clinical images) ● INFORMATION QUALITY
- potential for misinformation and non-expert advice to spread ● DIGITAL DIVIDE
- disparities in access and digital literacy (rural, elderly, disable populations) ● LEGAL AND ETHICAL ISSUES
- cross-border licensing challenges, liability risks, and copyright issues
● SOCIAL RISKS
- exposure to cyber bullying, stigmatization, and identity theft
Solutions and Recommendations
- development of clear social media policies by:
- professional bodies (e.g., ANA, AMA, NCSBN)
- education institutions
- healthcare organizations
- education and training for students and staff on ethical digital behavior
- use of secure platforms and anonymization for sensitive discussions
Historical Context of eHEALTH
- Roots in long distance communication.
- Progressed through telegraph, radio to digital systems.
- Telehealth evolved to multi-sensorial tech.
- Supports remote monitoring and rural healthcare access.
What is eHEALTH?
- use of web and tech in healthcare delivery
- global, tech-based care approach
- enables convenient, tailored patient communication
- empowers shared decision-making
What is TELEHEALTH?
- includes clinical and non-clinical services
- uses video conferencing, monitoring, store-and-forward
- supports education and environmental health
What is mHEALTH?
- mobile health using wireless tech
- supports clinical care and public health
- key in underserved regions globally
- enables care at a distance with mobile tools
eHEALTH Applications
- Non-Clinical : education, administration, data aggregation
- Clinical : diagnostics, remote monitoring, tele-specialties
- healthcare access in homes and rural areas
The Web’s Impact
- 85% of U.S. adults use internet; 56% via smartphones
- chronic illness patients use online support groups
- internet enhances information access and peer support
Consumer Engagement
- patient engagement framework (National eHealth Collaborative – NEHC)
- strategic use of eHealth tools
- shift to participatory healthcare model
Table 22.1 The Patient Engagement Framework
(National eHealth Collaborative, 2012)
Phase Description
Inform Me
The focus is onproviding information to assist patients in obtaining relevant materials.
Examples include use of mobile devices for directory services, access to basic health information for wellness and prevention, electronic access to standard forms (HIPAA, insurance forms, etc.), and specific information about tests, medications, and procedures.
Engage Me
The focus is onproviding patients with specific information concerning their care needs.
Examples include electronic tools to facilitate tracking of health and fitness behaviors, online tools to schedule appointments, and access to the electronic health record.
Empower Me
The focus is onenhancing patient involvement in the care process.
Examples include secure messaging and virtual coaching. In addition, patients could have the capability of generating their own data for the health record.
Partner with Me
The focus is on tools for shared decision making andcoordination of care across sites.
Examples include home monitoring devices and specific directives for patient preferences and intolerances.
Support my E-Community
The focus is on enhanced information exchange.
Examples include online e-community support
forums and e-visits with providers.
Personal Health Records (PHRs)
- owned and managed by patients
- enables tracking and sharing of health data
- example: Google Health platform
3. FUNCTIONALITY
- most visible task performed by the IT department, and therefore what they’re most commonly associated with in many workers’ minds
Roles of the Teams ➔ SYSTEM ANALYSIS
- translate clinical needs into technical requirements ➔ PROGRAMMERS AND DEVELOPERS
- build, customize, and troubleshoot the software ➔ DATABASE ADMINISTRATORS
- manage data storage, retrieval, and security ➔ NETWORK ENGINEERS
- ensure secure and reliable system connectivity ➔ SUPPORT SPECIALISTS
- handle end-user training and technical support
LISTSERV
- are email-based discussion groups that allow members (nurse, informaticians, developers) to share updates, resources, and best practices related to NIS
- this is often called mailing lists
- these are discussion groups in which members communicate with each other via email
- types:
- MODERATED
- Litservs generally have a person who looks over messages posted to the list
- UNMODERATED
- Listservs just pass along anything sent
NEWSGROUPS
- function similarly to forums and support asynchronous discussions on NIS issues, research and troubleshooting
- similar to Listservs, they collect postings or “news” (loosely defined) on a specific topic, users must visit the Newsgroup to get information
Difference between LISTSERVS and NEWSGROUPS : ➢ LISTSERVS
- all postings are immediately sent directly to you via email
- fairly constant
➢ NEWSGROUPS
- store their messages in a central location
- more transient
These tools are vital for: ● knowledge sharing across organizations ● professional networking for nurse informaticists ● problem-solving and feedback collection for system improvements
LEADERSHIP ROLE OF THE NURSE IN THE
MANAGEMENT OF NURSING INFORMATION SYSTEM
1. ADVOCATE FOR CLINICIAN NEEDS
- nurses bridge the gap between technology and clinical practice, ensuring that the NIS supports workflow, efficiency, safe documentation, and patient centered care
- nursing leaders require a variety of unique skills, including informatics, to support the delivery of safe and effective patient care
- CHANGE AGENT
- nurses facilitate staff buy-in, overcome resistance to change, and promote technology adoption by emphasizing the systems benefits for both nurses and patients
- SYSTEM DESIGNER / ADVISOR
- nurse leaders collaborate with IT and vendors during system selection, customization, and implementation to ensure alignment with nursing process and evidence-based practice
- EDUCATOR/TRAINER
- nurse leaders design training modules, support peer education, and contribute to ongoing competency development for clinical staff
- QUALITY AND SAFETY MONITOR
- they use NIS generated data to track clinical outcomes, identify care gaps, and promote evidence-based interventions
6. POLICY CONTRIBUTOR
- nurses help shape documentation standards, data governance policies, and informatics competencies across the organization
Impact of NURSE LEADERSHIP in the Management of NIS
- Leading the integration of clinical decision support tools to reduce medication errors.
- Advocating for user-friendly interfaces to reduce charting burden and improve nurse satisfaction.
- Using NIS data for nursing sensitive indicators (e.g., falls, pressure ulcers) to support quality improvement projects.
EXPLORING NURSING INFORMATICS
COMPUTER APPLICATIONS THAT
SUPPORT NURSING RESEARCH
What is a COMPUTER APPLICATION?
- program or group of programs designed for end-users to perform specific tasks on a computer or device — like word processing, web browsing, or photo editing
LITERATURE SEARCHES
- “organized search” to find key literature in a given topic
- “systematic” and“thorough” search
- DEFINE what you are searching for.
- DECIDE where to search.
- DEVELOP a search strategy.
- REFINE your search strategy.
- SAVE your search for future use.
How to Search Effectively?
- Identify Search Words or Keywords
- What are the main ideas?
- What concepts or theories have you covered?
- Where to Search: Databases
- it is advised to search for several databases to make sure you do not miss a key paper related to your topic
- Saved Searches – in many databases you can save a search to run a later data particularly if your search statement is complex and lengthy to enter
- Search Techniques
- once you have your keywords, combine them
- Boolean Logic which allows you to link your search terms (yes or no)
- Evaluating Information
- for quality and relevance
- Organizing the Information
- keep your information organized
- literature searches require you to keep track of articles
- bibliographic management tool can be used to help organize the references(APA format)
RELIABLE SEARCH ENGINES AND DATABASES
What is a SEARCH ENGINE?
- such as “Google” uses computer algorithms to search the internet and identify items that match the characters and keywords entered by the user
What is a DATABASE?
- allows you to efficiently search for published information such as magazine, journal and newspaper articles
What is the Importance of a Database? ● Reliable (Reliability)
- these articles have gone peer review process
- publication details are provided such as author’s name and year published ● Relevant (Relevance)
- these allow you to customize your search to get the most relevant result
- you can search by title or by author ● Accessible (Accessibility)
- provides access to the full text of an article so you do not need to go to the library to retrieve the articles in person
Why do we use Search Engines?
- this is useful for finding information produced by governments, organizations, groups, and individuals
Examples of EDUCATIONAL SEARCH ENGINES
- Google Scholar
- Google Books
- Microsoft Academic
- WorldWideScience
- Wolfram Alpha
- Refseek
- Educational Resources
- Information Center
- Research Gate
- BASE
- Infotopia
- PubMed Central
- Lexis Web
Types ofData Collection
- Quantitative Data
- expressed in numbers and summarized using statistics
- Qualitative Data
- when we use data for description without measurement
Types ofData
- Primary Data
- when data is obtained directly from individuals (both quantitative and qualitative)
- Secondary Data
- collected data from another researcher that were initially gathered
STATISTICAL TOOLS
- are mathematical formulas, models, and techniques that are used in statistical analysis of raw research data
RESEARCH TOOLS
ONLINE QUESTIONNAIRES
- designed through careful construction of questions to identify facts and opinions for specific groups of participants
ADVANTAGES DISADVANTAGES
- inexpensive
- practical
- fast result
- scalability
- comparability
- easy analysis
- validity and reliability
- no pressure
- dishonest answers
- interpretation issues
- accessibility issues
DIGITAL POLLS
- allows participants to communicate responses via internet, typically by completing a questionnaire via a web page or server
ADVANTAGES
- can reach wider audiences
