Chapter:14

Electronic Health Record System

APRIL 2004 president of the us issued an executive order that called for action to put electronic health record system (EHRS) in place for most Americans in 10 years. this order give momentum to effort across the health care community to use health information technology (HIT) to improve health care . Institute of Medicine (IOM) has been calling for the use of technology (IT) to improve the efficiency safety and quality of the health care Americans receive in a series of

ground breaking reports. modified this definition in its report, key capabilities of an (EHR-S) 2003. Electronic Health Record System (EHR-S) reiterating the new definition in a report on patient safety. used interchangeable with computerized pt. record, clinical information system

electronic medical record. reflects the breeder focus on the health of the consumer or pt. and indicates that

the EHR-S may be used by all participants in the process of achieving health, including all disciplines of clinicians family caregivers and the pt.

International Organization for Standardization (IOS) had drafted its standard for EHR definition scoop and context ISO 20514 the

final version was expected in 2005 or 2006. Federal Initiative within the federal government, different exerts different influences toward

the common goal of an EHR for American agencies providing direct health care offer evidence.

other agencies provide leadership by offering military incentives founding research development and demonstration project and shaping regulations and policy.

Government as provider early adopter their are two examples of national institute of health (NIH) and

department of health and human services (HHS).

Department of Defense (DOD) and the Indian Health Services (IHS) in the Department of HHS

both acquired the VA’s original clinical information system years ago customizing it to meet their clinical and business needs. Department of Veterans Affair in 2004 VA began implementing health the veteran as an internet tool for personal

health management. voluntary interact w/ subsets of their vist a health record and ultimately manage their

own personal health record (PHR) Veterans Health Information System and Technology Architecture (Vist A)- supports day to day clinical and administrative operations at local VA facilities health

care 1990 graphics use interface was added to bundle all existing function from Vist A Computerize Patient Record System (CPRS) provided a single place for healthcare providers to review and update the pt health

records and order medications special procedures, x-ray, nursing order, dicks and laboratory result

supports 158 hospitals and 854 clinics in processing 865,000 orders over half a million progress notes and 585,000 medication administered via VA’s bar code medication administered per day.

Department of Defense (DOD) providers have had a computerized physician order entry capability that enables them to

order laboratory test and radiology examination and issue prescription electronically for over 10 years.

January 2004 DOD began a world wide rollout of the next generation system the composite healthcare

system II (CHCS II) a secure scalable, pt centric EHRs II.

May 2004 CHCS II had more than 1.3 million pt encounters recorded in and

available from its data base. Indian Health Service (IHS) has long been a pioneer in using computer technology to capture clinical

and public health data. Resource and Patient Management System (RPMS) develop in the 1970’s,and many facilities have aces to decodes for

personal health information and epidemiological data on local populations. Patient Care Component (PcE)- place since the early 1980’s. Government as leader Federal agencies- do not provide direct care are taking multiple approaches to promote use

of EHR-S. decreasing the cost and risk of acquisition and providing incentives for their

use. target the sharing of electronic data across and among system to provide

a pt centric view of data across organize boundaries. Federal Activities focused on the development and adoption of terminologies and standards,

grants for community demonstration of data exchange and other pilot project. Government focusing in the development of a public-private national health

information network to facilitate EHR-S development. Office of the National Coordinator for Information Technology position to bring together public and private entities for accelerating

solutions to known problem.

April 2004 mentioned earlier in the chapter, created the ONCHIT to coordinate HIT efforts in the federal

sector and to collaborate of the private sector in driving HIT adoption across the healthcare system. David Brailer , MD, PhD was name to fill the subcabinet-level post. HHS Secretary Tommy Thompson and Dr. Brailer in July 2004,release a framework for strategic actions Office of the national coordination positioned to bring together public and private entities for accelerating solutions to known

problems. National health information network the technical infrastructure enabling national interoperability. Regional health information organizations now being propose at the community, regional, or state level, as mentioned in the discussion

of the agencies for healthcare research and quality (AHR-Q). National committee on vital and health statistics. 2000 and 2001 advises the secretary of HHS on health information policy held a series of national hearings

to develop a consensus vision of the national health information infrastructure (NHII) Information for health and NNHS in 2002 presented the concept of an infrastructure that emphasizes health oriented

interactions and information sharing among individuals and institutions, rather than simply the physical technical and data system that make those interaction possible.

NCHII including the values, practices, relationship, laws, standards, system, applications. - also encompasses tools such as clinical practice guidelines, educational recourses for the

public and professionals, geographic information system permitting regional's analysis and comparisons, health statistics at all levels of government

NCHVS and PHR’s core component of the NHII, enhancing the ability of each individual to

control his/her health data and the aces by the health care providers to those data. EHR’s and PHR’s both enable by the NHII in the senses that their optimal lye and

effectiveness requires the comprehensive infrastructure and enabler of the NHII. Agency for healthcare research and quality- in 2003-2004, AHRQ unveiled a major HIT portfolio w/ grants, contracts,

and other activities to demonstrate the role of HIT improving pt safety and the quality of care.

-$ 14 million was targeted for small and rural hospitals and communities. Return on investment (ROI) derive for the adoption, diffusion and use of HIT totaled approximately $ 10

million. Objective of these project was to provide health care facilities and providers w/ the

information they need to make inform clinical and purchasing decisions about using HIT.

AHRQ awarded the IHS $ 2 million in fiscal year 2004 toward the enhancement of

the IHS, HER. entities must be determine core health care entities for data exchange and

exchange 25 % of this core care data in the 1st years, 50% in the 2nd, and 100% in the 3rd.

funded demonstration grants to establish and implement interoperable health information system and data sharing to improve quality safety, efficiency on populations on a specific state or regional level.

contracted over $ 18 million for a health IT resource center to provide technical assistance, serve as repository for best practices.

2004 also funded five contracts of about $ 1 million/year for five years each for

state and regional demonstrations of health IT.

The three dimensions of the National Health

Information Infrastructure

Five entities 1. Colorado 2. Indiana 3. Rhode island 4. Tennessee 5. Utah State and regional grantees must involve variety of health care setting, including major purchasers of health

care; significant payers, both public and private, and providers, including hospital, ambulatory care facilities, home healthcare, and long term care providers

Center for Medicare and Medical Services initiated several pilot project to promote health IT. May 2004 awarded a $100,000 grant to the American academy of family physician (AAFP) for

a pilot project to provide comprehensive, standardized EHR software to small and medium size ambulatory care practices

AAFP to learn more about what factors facilitate or hinder smooth adoption of the

technology. Several large pilot program authorize in the 2003 Medicare modernization act (MMA).

Care Management Performance Demonstrations Program 3 years, Is intended to promote continuity of care, help stabilize medical condition,

prevent or minimize acute exacerbation of chronic condition and reduce adverse health outcomes, such as adverse drug interactions.

MMA develop a national standard for electronic rx, 80 that provider can share information

on what medications a pt is taking and to be alerted for possible adverse drug interactions.

Federal Government authorized to give grants to doctors to help them buy computer software, and

training to get ready for electronic prescribing. End of 2004 CMS lunched the chronic care improvement program (CCIP) AIM- to help beneficiaries manage their health adhere to the plans of care given by their

physician, and assure that they seck or obtain medical care that they need to reduce their health risks.

Public-private partnership- a no. of collaborative efforts are focused on the use of HER-Ss and HIT to improve care. Private sector Program formed specifically to address issue of connectivity, HIT and standards development. Connecting for Health supported by the Markel and the Robert wood Johnson addressing the barriers to development of an interconnected health information

infrastructure. 1st phase drove consensus on the adoption of an initial set of data standards develop case

studies on privacy and security and helped define the electronic PHR July 2004 release an incremental “roadmap” that laid out near term action necessary to

achieving electronic connectivity. eHealth initiative independent, nonprofit affiliated organization established to poster improvement in the

quality, safety and efficiency of healthcare through information and IT membership brings together hospital and other providers, practicing clinicians, community

organizations, payers, employers, community-based organizations.

Major program connecting communities for better health nearly $ 4 million program that provide seed funding and technical support

to multi stake holder collaborative w/in communities (both geographic and non geographic) that are using electronic health information exchange and other HIT tools.

Institute of Medicine (IOM) has championed the advantages of use of it to improve healthcare since

its 1991 foundational work. Computer- Based Patient Record was devise and republished in 1997 (Dick, Steen, and Detmer, 1991, 1997). IOM continues to eliminate the importance for the use of IT in healthcare. Summer 2003 at request of IHHS Certification Commission for Health It Goal this group is to support goal 1, strategy 2, “reduce risk of EHR investment”. Health Level Seven is known for its large body of work in the production of technical

specifications for the transfer of health care data. continues to have technical specifications for message as the primary body

of its work product but is changing to address. the trial period did not result in subsequent ballot’s, the draft status would

be expire at the end of 2 years period of 2004-2006. 3 categories 1. Direct Care Functions familiar to clinicians; these function are needed to support direct care

delivery.

2. Supportive Functions secondary use of the data captured via the direct care function; these

function support enhanced functions for direct care. 3. information Infrastructure “back end” of the system unfamiliar clinicians. Use Profile develop by clinicians to provide care to their pt population. Product Profile customized to describe a vendor product.

Referenceso Committee on Data Standards for Patient Safety.(2003). Key Capabilities of an Electronic Health Record System: Letter Report. Washington D.C: National Academies Pesso Health Information and Management Society (HIMSS).(2004,September 1). Certification Commission for Healthcare Information Technology Names Inaugural State of Commissioners. Retrieved October 8,2004,from http.//himss.org/asp/Content Redirector.asp?contentid=547=97o Health Information and Management System Society (HIMSS).(2003).Position Statement: National Health Information Infrastructure. Retrieved June 21,2004, from www.himss.org/content/files/NHII_Fact_Sheet .pdfo International Standard Organization, Technical Standard (ISO/TS) 18308.(2004).Requirements for an Electronic Health Record Reference Architecture. Retrieved October 7,2004, from www.iso.org/iso/en/CatalogueDetailPageo National Committee on Vital and Health Statistics (NCVHS).(2002).Information for Health: A Strategy for building the National Health Information Infrastructure. Report and Recommendations Washington,DC:US. Department of Health and Human Services www.ncvhs.hhs.gov/nhiilayo.pdf

Chapter15

Dependable Systems for Quality Care

Health Care Industry is under going a dramatic transformation from today's inefficient, costly,

manually intensive, crisis driven model of care delivery to a more efficient, consumer-centric, science based model that proactively focuses on health management.

Electronic Health Record (EHR) form the function for pervasive, personalize, and science based care. Clinical Information System (CIS) integrated, outcomes- based decision support, clinical knowledge bases.

Computerized physician order entry (CPOE). Enterprise Applications Integration (EAI) wireless communication; handled tablet computer; continues speech recognition. Internet Council of Nurses (ICN) code of ethics for nurses affirms that the nurse “holds” in confidence personal

information and “ensures that use of technology”..compatible with the safety dignity and right of people.

Six attributes 1. System Reliability the system consistently behaves in the same day. 2. Service Availability required services are present usable. 3. Confidentiality sensitive information is disclose only to those authorized to see it. 4. Data Integrity data are not corrupted or destroyed. 5. Responsiveness the system respond to user input within an expected and acceptable time period. 6. Safety the system does not cause harm.

March 2013 Kaiser Permanente learned how the lack of dependability can affect its business. force to contact 4,700 people to verify their orders. one month after the Kaiser incident, a new laboratory computer system at the los

Angeles medical center overloaded, forcing the emergency room to turn away the ambulances when the day appeared at the door.

August 2003 blaster and so beg worm attacks invaded hospital around the world. Glascow and Scotland 10,000 computer use by city hospital and emergency services were infected, and

system at one hospital were down for 15 hours. 1/3 of the computer at Baylor college of medicine. exceed $100 K and 25 days productivity were lost campus wide due to system

outages. Guidelines for dependable system all computer system are vulnerable to both human created threats, such as

malicious code attacks and software bugs, natural threats, such as hardware aging and earthquakes.

Guidelines 1: architect for dependability a fundamental principle of system architecture is that an enterprise system

architecture should be develop from the bottom up so that no critical component is dependent on a component less trustworthy than itself.

one or more computer are connected to this network, and the software foundation of each computer is an operating system, that is responsible for managing all of the resources in the computer system.

Single point dependencies should be avoided or eliminated. No Single dependencies should be capable of bringing the system town should that component fail.

Category 1 Category 2 Category 3 Category 40

1

2

3

4

5

6

Series 1Series 2Series 3

System Architecture

Guidelines 2: anticipate failures - anticipate failure they will happen. Guidelines 3: anticipate success -anticipate business success- and the consequential need for larger networks more

system, new applications and additional integration. Guidelines 4: hire meticulous managers managing and keeping complex networks and integrated system available and

responsive requires meticulous overseers- individuals who knows that failures occur and accept that failures are most likely to occur when they are less expected.

-they take emergency and disaster planning very seriously; they develop maintain; and judiciously experience plans and procedures for managing emergencies and recovering from disaster.

Guidelines 5: don’t be adventurous the products brochure urges the consumer to be adventurous and states that the

company guaranties satisfaction or the purchasers money will be carefully refunded. dependability, one should use only at a scale similar to the intended environments. proven methods, tools, technologies, and product that have been in production under

conditions and at a scale similar to the intended environments.. Assessing the healthcare industry healthcare clearly has a need for dependable system- both now and after the

transformation, as the industry becomes increasingly dependent on IT in the delivery of the pt care.

assessment is by no means “scientific” nor is it intended to represent “all” healthcare provider organizations.

Healthcare architectures the Healthcare professionals select the users interfaces they like, and the IT team

negotiates terms with the vendors who offer the system that generate those interfaces.Healthcare insurance portability and accountability act (HIPAA) security regulation prescribe administrative, physical and technical safeguard for

protecting the confidentiality and integrity of health information and the availability of critical system services.

HEALTH CARE INDUSTRY

YearStudent NameSubject:

2004

Clinical Care Provider Community

Information Technology Dependability

Guideline Grade

Comments

Architect for Dependability

D Builds system top down instead of bottom up . Too complex

Expect Failures

D Assumes systems will work

Expect success

C Assumes systems and network are infinitely expandable and adaptable, but does not plan for systems expansions and consolidations

Hire Meticulous Managers

C Sometimes, but doesn’t give them adequate support.

Don’t Be Adventurous

C Yes and no.

8 required administrative safeguard 1. security management,. Including security analysis and risk management. 2. assigned security responsibility. 3. information access management, including the isolation of clearing house functions from other clinical functions. 4. security awareness and training. 5. security incident procedures, including response and reporting. 6. contingency planning, including data back up planning, disaster recovery planning for emergency mode operations. 7.evoluation 8. business associate contracts that lock in the obligations of business partners in protecting health information to which they may have access. Five specified physical safeguard 1. access control, including unique users identification and an emergency access procedures. 2. audit control 3. data integrity protection 4. person or entity authentication 5. transmission security HIPAA “information system activity review” important safeguard to

counterbalance the necessary of authorizing many people access to pt record. Anticipating failures 2nd guidelines “expect failure” the clinical care provider community gets

another grade of “D”.

Personal data assistants (PDAs) have a higher likelihood of failure than application hosted on server machines that

are physically protected, manage by trained system administrator and continuously monitored. PCs connect to the enterprise network from outside, laptops with wireless modems,

smart phones and PDAs that synchronized with enterprise system. Computers increasingly being used in safety critical clinical application, and without careful and

appropriate attention to software safety, we can reasonably expect that failures will contribute to the loss of human life.

Between June 1985 and January 1987 therac 25 massively overdose six people, resulting in deaths and serious injuries. Therac-25 incident FDA has improve its reporting system and augmented its procedure and guidelines to

include software. FDA requires failure modes of effect analysis for product with software components, which

helps detect errors in software controlled, medical devices that requires FDA approval. CIS product companies incorporate software safety design and assurance method in their

development environment. Anticipating success 3rd guideline “expect success” the clinical care provider community has earned a

Medicare grade of “C” Healthcare organization definitely expect their software applications, computer system, and networks to work. do not foresee that their business success may increase their need for processing

power and networking capability.

Boston care group instance discussed earlier offers a good e.g. of a hospital that did not

anticipate its own success and the resultant needs for its network to grow. 1996, Beth Israel hospital implemented a state of the art network . November 2002 highly successful care group was running is critical clinical

applications on a vintage 1996. Spanning tree protocol A switched network uses something. To figure out the shortest route to

send network traffic to its destination. Management fourth guideline “expect success” the clinical care provider community

has been assigned a Medicare grade of “C”. who recognize the strong relationship between system dependability

and the quality and safety of pt. care implement fault-tolerant system with strong security protection.

Health care organizations view IT as a “support function” and costly business expanse,

frequently select IT manages who may understand the healthcare business. IT environment tend to be loose composites of proprietary. Past decade healthcare has invested only 2% 5 its revenues in IT. Compared to

10% for other information-intensive intensive industries.

$8000 per worker per year for technology. $1000 per worker for healthcare. Adventurous technologies in healthcare Fifth and final guideline “don’t be

adventurous” is the most difficult to assess for healthcare.

HIMSS 2004 technology leadership survey found that 72% of the surveyed healthcare

organizations had wireless networks. Wireless networking and hand held comp. clearly- central to the ability to

provide pervasive care in the future. Wireless technology express and product vendors are working

diligently toward comprehensive security solutions, but such solutions have not yet arrived.

Referenceso Department of Health and Human Services(DHHS). (2003).Health insurance reform; Security standards, Final rule.45 CFR parts 160, 162. and 164 Federal

Register.o Health Information Management System Society (HIMSS).(2004).15th Annual HIMSS Leadership Survey . sponsored by Superior Consultant Company, Inc. Final report: Healthcare CIOo International Council of Nurses(ICN).(2000).The ICN Code of ethics for nurses . Geneva, Switzerland. Retrieved July 9, 2004, from http://www.icn.ch/icncode.pdfo PDA cortex.(2004).Mobile Computing in Nursing Study. Retrieved July 9, 2004 , from

http://www.rnpalm.com/Mobile_Computing_Nursing_Study.htmo President Bush Touts Benefits of Health Care Information Technology.(2005).Washington, DC: The White House. Available at http.//www.whitehouse.gov/news/releases/2004/04/20040427-

5.html

Chapter 16 Nursing Minimum Data Set System

Clinical Nursing Visibility from National to International Context provide a synthesis of historical currents and future NMDS system which can

increase nursing data and information capacity to drive knowledge building for the discipline and professions and contributes to the standards supportive of the HER

NMDS identifies essential, common and core data elements to be collected for all

pt/clients receiving nursing care. conceptualize through a small group work at the nursing information system (NIS)

conference held in 1977 at the university of Illinois college of nursing. 64 conference. Werley and Categories took the NMDS for ward at the NMDS conference in 1985. 3 Board Categories of Elements A. nursing care. B. pt or client demographics C. service elements AIM not to be redundant of other data sets, but rather to identify what are the

minimal data needed to be collected from records of pt receiving nursing care. 8 benefits of the NMDS. 1. access to comparable, minimum nursing care, and resources data on local, regional,

national and internal levels. 2. enhance documentation of nursing care provider. 3. identification of trends related to pt/client problem and nursing care provided. 4. impetus to improved costing of nursing services. 5. improve data for quality assurance evaluation. 6. impetus to further development and refinement of NISs

7. comparative research on nursing care, including research on nursing diagnosis, nursing intervention, nursing outcomes, intensity of nursing care and referral for further nursing services. 8. contribution toward advancing nursing as a research based discipline NMDS influence the work of the professional nurses association. 1991 American nurses association (ANA) recognize the NMDS as the minimum

data elements to be included in any data set or pt record. ANA establish the American nurses association steering committee on data bases

to support clinical nursing practice. launched a recognition process for standardized nursing vocabularies

needed to capture the NMDS data elements for nursing diagnosis, interventions and outcomes in a pt record.

II languages have been recognize by ANA. NMDS serves as a key component of the standards develop by the nursing

information and data set evaluation center (NIDSEC) has supported nurse’s participation in developing computerized health

information system (HISs), utilization of data and information to support evidence based.

work in the U.S. American association of colleges of nursing (AACN) white paper in the clinical nurse leaders is one example of the recognition of

the essential core function of the informatics expertise w/in practice. seven countries have identified

NMDS system 1. Australia 5. Netherlands 2. Canada 6. Switzerland 3. Belgium 7. Thailand 4. Iceland Emergent NMDS North America exploring development of NMDS system. Europe WHO has been concerned with variables including nursing care, personal

data, medical diagnosis and service data. U.K work is ongoing. Scotland identify NMDS to be congruent with the initiatives of the national

health service. Nordic countries ongoing activity to identify NMDS. France pursuing identification of a NMDS. Brazil leading efforts in south America to identify a NTADS. Korea and Japan focusing in the development effort as well. New Zealand focus effort on a diabetes specific data set to date.

Call for standardize contextual data Ample studies have demonstrated the significance of nurse staffing, pt/

stafrations, professional autonomy and control organizational characteristic, unit internal environment, staff work satisfaction, education of staff, multidisciplinary coordination collaboration and educational level on the quality of outcomes of pt care.

e.g. Belgium calls for data related to # of beds and # of nurses available. 18 NMMDS elements are organized into 3 categories. 1. environment 2. nursing care resources 3. financial resources NMMDS minimum set of items of information with uniform definitions and categories

conserving the specific dimension of the context of pt/client care delivery. focuses on the nursing delivery unit/service/center of excellence level across

these setting. NMDSs relationship to international nursing minimum data set (i-NMDS) Evaluation of concept. i-NMDS core, internationally relevant, essential minimum data element to be collected

in the course for providing nursing care.

Encouraged to establish triads composed of.A. Representative (s) of the national nurses association (preferably international

council of nurses [CN]member.B. International medical informatics association nursing informatics special interest

group (IMIA NI-SIG) representative.C. Informatics expert

Project teams provide coordination and communication of project work in each country. i-NMDS project in intended to build on and support data set work already underway in

individual countries, as well as the work w/ another ICN initiative, the ICPN. i-NMDS project focuses coordinating on going international data collection and analysis of the i-NMDS

to support the description, study, and improvement of nursing practice. Cosponsor ship i-NMDS research center lead by a sheering committee of international representatives of countries w/

existing and emerging NMDS’s as well as professional Cosponsor ship. Project Cosponsor ship by the ICN and the IMIANI-SIG. Project work also coordinated w/ international standards organizations and other slake

holders to assure harmonization of these efforts. purposes i-NMDS as a key dataset will support• describing the human phenomena, nursing intervention, care outcomes, and resource

consumption related to nursing services.• Improving the performance of health care system and the nurses working within these

system world wide.• Addressing the nursing shortage, inadequate working conditions, poor distribution and

inappropriate utilization of nursing personnel, and the challenges as well as opportunities of global technology, innovation.

• Testing evidence based practice improvements.• Empowering the public internationally.

Data elements i-NMDS elements organized into 3 categories 1. Setting country characteristic as well as description of the location of

care, whether Acute, ambulatory, home and so on. 2.Subjects individuals, families, groups or communities. Nursing Care Data collected using standardized languages. 3.Nursing Care Elements nursing diagnose/subject of care problem; interventions, and

outcomes. Issues continuing attention needs to focused on consistency w/ the i-

NMDSs across all countries. Future Directions the power of NMDSs to describe nursing from an international

perspective is daunting. Information and Knowledge key to supporting an essential knowledge driven professional

service and improving healthcare through effective policy changes.

Referenceso Aiken , L.H., Clarke, S. P., Cheung, R. B., Sloane, D. M.,And Silber, J.H. (2002). Hospital nurse staffing andPatient mortality, nurse burnour and job dissatisfaction.Journal of the American Medical Association288(16):1987-1993.o Delaney, C., Goosen, W., Park, H., Junger, A., Oyri,, K., Saba , V., and Coenen , A . (2003)., Seeking international consensus on elements of the international nursing minimum data set (iNMDS)[abstract].In H.Marin, E.Marquez., E.Hovenga, and W.Goosen (eds)., Proceedings of the 8th International congress in Nursing Informatics(pp.74-75)

•Chapter 17

Theories, Models, and Framework

Foundational documents guide nursing informatics practice. 2001 ANA published the code of ethics for nurses w/ interpretative statements, a

complete revision of previous ethics provisions and interpretive statements that guide all nurses in practice, be it in the domains of direct pt care, educ, adm. Or research.

Terms decision making, disclosure, outcomes, privacy, confidentiality, disclosure,

policies, protocols, evaluation, judgment, standards, and factual documentation about through out the explanatory language of the interpretative statements.

2003 2nd foundational professionals document, nursing social policy statements second

edition, provide a new definition of nursing. Nursing is the protection, promotion and optimization of health and abilities, prevention of

illness and injury, alleviation of suffering through the diagnosis and tx of human response, advocacy in the care of individuals, families, communities, and populations.

Early 2004 further reinforces the recognition of nursing as a cognitive profession. 1st Assessment data collection begins the nursing process. 2nd step diagnosis/problem definition reflects the interpretation of the data and information gathered during

assessment. 3rd step out comes identification 4th step planning 5th step implementation

Nursing process literature, includes numerous feedback ropes and incorporates evaluation activities

throughout the sequencing. Informatics and health care information. Informatics science that combines a domain science comp. science information science,and cognitive science. Healthcare informatics defined as the integration of health care science, comp science, information

science, and cognitive science to assist in the management of the healthcare information. sub discipline of informatics. relatively young addition to the informatics umbrella, you may see other terms

that seem to be synonyms for this same area, such as health informatics or medical informatics.

Medical informatics used in Europe. more clearly a sub domain of healthcare informatics and health informatics may

mean informatics used in educating healthcare clients and/or the general public. evolves so will the clarity in definition of terms and scoop[s of practice. addresses the study and management healthcare information. Nursing informatics unique areas that address the special information needs for the discipline of

nursing. 1985 (Kathryn Hanna) proposed a definition that nursing informatics is the use of information

technologies in relation to any nursing function and action of nurses. graves and Corcoran presented a more complex definitions of nursing informatics.

ANA

defined nursing informatics as the specially that integrates nursing science comp. Science and information science in identifying, collecting, processing, and managing data and information to support nursing practice, adm, education, research and the expansion of nursing knowledge.

2000

ANA convened 90 expert panel to review and revise the scope and standards of nursing informatics practice.

Staggers and Thomson's 2002 JAMIA ARTICLE

“the evolution of definitions for nursing: a critical analysis and revised definitions”

Nursing informatics as a specially Early 1992

established nursing informatics as a distinct specially in nursing with a distinct body of knowledge.

American nurses credentialing center(ANCC)

establish a certification examination and process in 1995 to recognize those nurses with basic informatics specially competencies.

Model for nursing informatics Models

representations of some aspect of real world.

Direct depiction of their definition of nursing informatics.

provides a framework for identifying significant information needs which in turn can foster research.

Four elements1.Raw mat.(nursing related information)2.technology( a computing system)3.users(nurses, students and context)4. Goal or object toward which the preceding elements are directed. Bidirectional arrows connect the three base components system to form the pyramids

triangular base. 1996 proposed another model in which the core components of informatics

are depicted as intersecting circles. Nursing science larger circle that completely encompasses the intersection between

circles. Data information and knowledge Current met structures or overarching concepts for nursing informatics

with specific definitions in the” scope and standards of nursing informatics practice”.

ANCC expert panel has oversight responsibility for the content of this

examination and considers the current informatics environment and research when defining the test content outline.

System life cycle

system planning, analysis, design, implementation and testing, evaluation, maintenance, and support.

Information Management and Knowledge generation

Data, information, knowledge. Professional practice, trends and issues

roles, trends and issues, ethics. Healthcare Information and Management System Society

established a certification program that may be of interest to informatics nurses.

EHR Healthcare Environment

characterized by significant emphasis on establishing the EHR in all settings. Data sets

comprised of data elements brought together for a specific person. Modern database

used for storing data in a way that maintain the logical relationships among data elements, and are stored in a computer.

Focus

client health record as a database. Simple Perspective

that the EHR is a client health record database support by computer, electronic, and communication technologies.

American Society for Testing and Material(ASTM) any information related to the past, present or future physical/mental health, or condition

of an individual.

Terminologies Nursing Minimum Data Sets(NMDS)

developed Dr. Harriet Werleys considered the foundational work for nursing languages and represents the 1st attempts to standards the collection of essential nursing data.

Four nursing care elements1. Nursing diagnosis2.nursing interventions3.nursing outcome4.intensity of nursing carePt/client demographic elementsAddress personal identificationDate of birthGenderRaceResidenceSeven service elements1.unique facility or service agency number2.Unique health record number of patient3.Unique number of principal RN provider4.Episode admission or encounter data 5.Discharge or termination date6.Disposition of patient7expected payer.