NURSING MANAGEMENTUNIT X (10) NURSING INFORMATICSINTRODUCTION

The worlds of health care, communication, and information technologies are ever evolving, separately and together. As nurses in the community expand their practice definition to embrace new information technologies, opportunities for improved health care to populations seem endless. This evolution is seen as a merger of health care technology with information and communications technology, fostering the design and implementation of health care management information systems in a variety of clinical practice settings. the clinical practice settings involved in this new technology include both the acute care and community-based practice environments. Organizations such as hospitals and community-based agencies such as public health departments and home agencies use information and communications technologies to collect, restore, retrieve, analyze, and present client care data in the care delivery settings. Health care continues to be a human endeavor that is necessarily complex in nature. Decisions related to client care continue to increase in complexity, with the need for rapid, accurate information for clinical decisions making as a priority for effective care.

Nurses have been delivering compassionate care using technology since the time of Florence Nightingale. Technology, coined from the Greek language “tekhnolohiga” meaning systematic treatment, is defined as a scientific method of achieving a practical purpose. As healthcare evolves to meet the needs of mankind, nurses are faced with greater challenges on how to apply technology in practice, education, and research. Now more than ever, the term technology exponentially covers a greater meaning in healthcare to include informatics.

Coined from the French word “informatique”, Gorn (1983) first defined informatics as computer science plus information science. As it relates to nursing, it has been labeled as Nursing Informatics.

American Nurses Association Scope and Standards (2001) defines Nursing Informatics as a specialty that integrates

1) Nursing science, 2) Computer science, and 3) Information science 4) To manage and communicate data information and knowledge in nursing

informationDefinition

Informatics

Informatics generally can be defined as the art and science of turning data into information. The more recently informatics defined as the study of the application of computer technology and statistical techniques to the management of information. Medical informatics refers to the application of informatics to all of health care disciplines as well as to the practice of medicine. Nursing informatics is the use of information and computer technology to support all aspects of nursing including the direct delivery of care, administration, education, and research.Nursing Informatics uses nursing science, computer and communications technologies to produce effective and efficient client outcomes for individuals and communities. Nursing informatics, as originally defined, refers to the use of information technologies in relation those functions within the purview of nursing, and that are carried out by nurses when performing their duties. 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 and Corcoran, 1989).

Informatics helps nurses in project management, consultation, clinical, practice, administration, education and research, so all nurses need to establish a level of awareness and competence in it.

TRENDS Nuring informatics is a combination of computer, information & nursing sciences. This new & expanding field addresses the efficient & effective use if information for nurses. Preparing nurse for computerization is essential to confront an explosion of sophisticated computerized technology in the work place. It is critical in a competitive health care market for preparing nursing to use the most cost effective methods. A model is presented that identifies six essential factors for preparing nurses for computerization. They are

Strong leadership Effective communication Organized training sessions Established time frames Planned change Tailored software

LEADERSHIP IN NURSING INFORMATICSNursing informatics is a 21st century science with great potential for improving the

quality, safety & efficiency of health care.

Perinatal, neonatal & women’s health nurses have an opportunity to contribute & lead in informatics.

Leaders must learn about current informatics issues from essential resources, including the literature, professional organizations & education programs to develop successful strategies for innovation collaboration & implementation.

As nurses have been practicing in the automation of healthcare data and the integration of nursing data within information systems, a realization of the need for agreed-on definitions of the appropriate elements describing clients and their care came to light. (Grier, 1984; Mortiz, 1990).

Werely and Lang 1998, have identified and described the need for a standardized data set in nursing, the Nursing Minimum Data Set in Nursing, the Nursing Minimum Data Set( NMDS). Adoption of the NMDS would allow for an ongoing collection of data that can be compared across setting and client populations for clinical and administrative decision making.

According to the study groups on Nursing Information Systems (1983), computerizing the data facilitates the management and use of the information by standardization, organization and automation to produce timely and comprehensive information. The NMDS provides structure for electronic storage of nursing data, and the unified nursing language provides the substantive data definition to be stored in that structure  (Hannah& Shaniman, 1992).

GENERAL PURPOSE Nursing’s data needs fall into four domains: Nurse need data about client care, provider staffing, administration of care and the organization, and knowledge based research. The first three are distinct areas, whereas research interacts with all of the other three. The four areas and the source for the data are:

Client: client care/ clinical care and its evaluation, clinical data, and client outcomes. Source: the client record.

Provider: professional data, caregiver outcomes, and decision maker variables. Source: personnel records, national data banks, and links to client records.

Administrative: management and resource oversight, administrative data, system outcomes, and contextual variables. Source: executive/ managerial data and fiscal and regulatory data.

Research: knowledge base development. Source: existing and newly gathered data and relational data bases.

USE OF COMPUTERS IN HOSPITAL AND COMMUNITY Computers & informatics are assuming an increasing important role in increasing the efficiency of health care systems. Computers are increasingly a part of interdisciplinary team communication & cause documentation in acute care hospitals. Computerized

charting has become a common place with more institutions moving toward the use of tablet, personal computers. They have an important role in hospital stores management including cost containment & effectively in inventory management.

Use of computer in hospitalComputers has been used in 4 main areas. It includes:

1. Use of computer at the administration level Administrative responsibility for medical records Administrative uses of medical record information Administratively significant functional requirements of medical record

automation Data elements Critical aspects of medical record that account for its current strengths &

weakness2. Computers in hospital store management3. Use of computer for the patient needs4. Tele health & tele nursing.

NURSING RECORDS AND REPORTS Good health care administration depends upon the good reports & records. Reports & records are good tool or vehicle for fragmenting information from downward to upward to downward communication. All professionals need to be accountable for the performance if their duties to the public since nursing have been considered is profession, nurses need to record their work on completion. A record is a permanent written communication that documents information relevant to ancient health care management.

DefinitionA record is a clinical scientific, administrative & legal document relating to the nursing care gives to individuals family or community.

The records are a practical & indispensable & to the doctors, nurses & paramedical personal in giving the best possible service to their clients.Purposes

Records provide data for programme planning & evaluation Records are the tools of communication between the health workers, the family &

others development personal Records indicate plans for the future Records provide baseline data to estimate the long term changes related to the

survives Records provide as opportunity for evaluating the services Help is the research for improvement of nursing care

Importance of records in hospital health centre: A medical record should furnish all health care providers with concise, accurate,

written picture of patients medical & nursing problems, care planned & gives, & the patients responses to treatment

The chart or health care record has been more important in the health care system than it is today, it is legal record than in used to most the mammy demands if the health accreditation, medical insurance & legal system

Reports are oral or written exchanges of information shared between caregivers or workers in a number of ways. A report summarizes the services of the person or personnal and if the agency reports usually written, daily, weekly, monthly, or yearly.

Purposes To show the kind & amount of survives rendered over a specified period To illustrate program in reaching goals As an aid in studying health condition As an aid in planning To interpret the services to the public & to the other interested agencies

Types i) Oral report

Oral reports are given when the information is for immediate use & not for permanencyEg. Oral report is made by the nurse who is assigned to patient care, to another nurses who is planning to relieve her, & some if the oral reports may be made to charge nurses & nurse supervisors & also doctors

ii) Written reports

Other typesi) Changes of shift reportsii) Transfer reportsiii) Incident reportsiv) Legal reports

MANAGEMENT INFORMATION AND EVALUATION SYSTEM (MIES) An organization is primarily a system of people, methods & means to attain some pre determined objective

The efficient functioning of any organizational system largely depends upon the continuous process. Of information flow in which information is received, stored, processed & exchanged.An effective MIS can provide a manager the needed information in the light form, at right time & right place.

DefinitionManagement information system is defined as to describe a broad class of information systems that are designed to provide information needed for effective decision making by managers

E- NURSING, TELEMEDICINE, TELENURSING Definition of E-NursingThe changes that have occurred in computers & information technology since 1982 are amazing. Computers are in automobiles, home spplisnces, & home electronics. Personal computers are in the machines debit cards, & electronic banking are now the norm for dealing with money.

Definition of Tele medicineThe delivery of health care services, where distance is a critical factor, by all communication technologies for the exchange of valid information for diagnosis, treatment & prevention of diseaseTelemedicine includes all types of physical & psychological measurements that do not require a patient to travel to a specialist. When this service works, patients need to travelers to a specialist or conversely the specialist has a large catchments area.

Definition of Tele NursingTele nursing refers to the use of telecommunications & information technology for providing nursing services in health care whenever a large physical distance exists between patient and nurse or between any number of nurses

ELECTRONIC MEDICAL RECORDSElectronic medical records are comprehensive data of patients admitted to the hospital.

They are similar to folders which contain all the patient details. These details are confidential & can be accessed only by authorized personnel.

Electronic medical records is a computerized legal clinical record created in care delivery organizations such as hospitals & physician officers & used & owned by the delivery organizations. It becomes an electronic health record when

Reports & histories (laps, pharmacy, radiology, consults etc) are electronically added

Items in the record are electronically exchanged with other providers & There is a personal health record component which allows patient to participate is

documenting & creating their medical history & communicate with their provider.

Features of electronic medical records1. Integrated with appointments, OPD billing, laboratory diagnostic imaging2. Predefined medical records formats each discipline wise is provided for easy

storage & retrieval3. Facilitates in maintenance of electronic record of the patient medical history, family

history, allergies, diagnosis & treatment advised to the patient each visit wise4. Direct entry & communicating the clinical orders to different departments5. Varies investigation reports & radiology images for the test advised6. Viewing of in patient records also after discharge from the hospital in the

subsequent visits7. Update patient disease diagnosis & medication details in the smart card for ready

reference8. Send patient records through web to another consultant at different location for

cross consultation

Benefits of Electronic medical Records1. More responsive health care practices2. Improved administration in medical facilities3. Improved medical practices workflow4. Enhance patient experience because of process efficiencies5. Medical records & patient charts6. Instant messaging to improve office administration7. Electronic medical billing8. A flexible transcription tool

Eight functions of electronic medical records Health information & data Result management Order management Decision support Electronic communication & connectivity Patient support Administrative processes Reporting

Characteristics of Electronic Medical Records

1. AccessibilityAccessibility would be enhanced if the researcher well able to link patient record data across files within & across institution, at a minimum this means common identifies. Records must also be obtainable via institution of individual permission a key consideration for most health services researchers who use the patient record

2. StandardizationThe more standardization the greater the usefulness of the patient record to health care researchers. This includes not just formatting conventions & coding schemes, but extends to the definition of the variables themselves. Because most studies require large samples, standardization must apply not only within but across setting to maximize the usefulness of the patient record

3. SimplicityPatient records that were simple to access & use would be born to health care researchers. Standardization of format as noted above would increase simplicity, as would the availability of documentation, particularly for the contents of electronic record files.

4. AccuracyFor the health care researchers, accuracy refers not only to the data elements themselves, but to associated documentation (eg: of access rules, file, contents, location, variable definition, values) Data in the records themselves as well as those in record based sources, must be reliable in that they reflect & agree across sources.

5. CompletenessCritical here is that the record represent as much of what happened during care as possible hence the usefulness of a unit record. A unit record with partial information may not however be more useful than multiple records that can be linked. Another critical issue is whether missing data can be interpreted as in directing normal values & usual occurrences or representing errors of omission

6. Cost-EffectivenessPatient records that fulfil the above requirements would be a cost effective source of data, another key consideration for health care researchers.

Advantages of Electronic medical patient’s clinical record Better medical care Individual health maintenance Patient education Linkage, storage & transfer of medical information Cost saving Physician acceptance Office clinical efficiency Compute easy

Disadvantages of Electronic medical records Computer crashes Unfamiliarity Maintaining confidentiality with complete charting Never share your password or computer signature Log off if not using your terminal Follow protocol for correcting errors Make backup Never display patient information