2. INTRODUCTION
• Health care is delivered in dynamic, complex, and
ever changing environment
• Changes in medical treatments, regulations for federal
and state reimbursement and public knowledge create
growing demands for information.
• Computer has moved from “nice to know” luxury
item to “need to know”.
• On average medical/ surgical nurse spent 34% of
their time handling information
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3. Definition of Nursing
Informatics
• 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.
-Graves & Corcoran,1989
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4. Definition of Nursing
Informatics (2)
• Nursing informatics is using technology,
research, and professional experience to
manage nursing data, information, and
knowledge to improve practice and deliver
better health care.
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6. Historical development
• Healthcare began to use computers in the 1950’s.
• Computers, in this era, were typically used in the
business office.
• In the 1970’s, nursing began to realize the importance
of computers to the nursing profession and became
involved in the design, purchase, and implementation
of information systems
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7. Historical development…
• In the 1980’s, medical and nursing informatics
specialties emerged.
• 1995 saw the first certification exam for NI.
• The post-2000 era saw an unprecedented
explosion in the number and sophistication of
both computer hardware and software.
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8. Historical develpoment…
• Telemedicine became possible and was
recognized as a specialty in the late 1990’s .
• NI has experienced rapid growth in the last 40
years which does not appear to be slowing.
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9. All Nurses Must
•Possess computer skills
•Be able to use applications,
and
•Know how to manage
information and knowledge
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10. Why is it important?
•Informatics enables nurses
to use information and
communications technologies
in the:
collection of data,
use of information
generation of knowledge
to support nursing practice
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Technology
Nursing
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11. Nursing information system
Nursing Information Systems
• When time and energy are at a premium, using a Nursing
Information System (NIS) in acute care settings can assist in
applying nursing knowledge and wisdom to everyday care
• Documentation can be more timely, more complete, and more
accurate when captured at the “point of origin”, usually the
client’s bedside in acute care settings.
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12. Functional Areas of Nursing
Informatics : ANA Scope and
Standards of Practice
•
•
•
•
•
•
•
•
•
Administration, leadership and management
Analysis
Compliance & integrity management
Consultation
Coordination, facilitation, & integration
Development
Educational & professional development
Policy development & advocacy
Research evaluation
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13. The goal of nursing
informatics….
• is to improve the health of populations, communities,
families, and individuals by optimizing information
management and communication. This includes the use of
information and technology in the
•direct provision of care
• in establishing effective administrative systems
• in managing and delivering educational experiences
• insupporting lifelong learning
• in supporting nursing research”
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14. The Value of Nurse
Informaticists
• Support
nursing work processes using
technology
– Design systems to match clinical workflows
Telehealth
Home health
Ambulatory care
Long-term care
Acute care – all specialties
Outpatient settings
Software development
Redesign work flows
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15. The Value of Nurse
Informaticists
• Increase the accuracy and completeness
of nursing documentation
• Improve the nurse’s workflow
– Eliminate redundant documentation
• Automate the collection and reuse of nursing data
• Facilitate analysis of clinical data
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16. Using information
• Evidence-based practice leads to:
– Determining standards and guidelines
– Guide for decision-making process
– Determines best practice
• Nursing informatics can enable dissemination of new
knowledge.
– Practitioners update themselves of new developments
through journals, conferences, continuing education
sessions.
.
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18. The Benefits of Nursing
Informatics
• In the practice of professional nursing
• In the delivery of patient care in the
healthcare continuum
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19. The Benefits of Nursing
Informaticists
•Benefits for nurses and the interdisciplinary team:
a. Support for their mission to deliver high quality,
evidence-based care
b. Support for better service by facilitating true
interdisciplinary care
c. Promotes improvement in key relationships with
physicians, peers, interdisciplinary care team
members, patients and families
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20. EDUCATION IN INFORMATICS
Both formal and informal education for
nursing informatics are available. Needs B.Sc
(N) plus a second degree in computer science
or information technology
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21. Formal informatics
• Category I- it is a graduate programs with a
specialist nursing informatics focus.
• Category II- in this program students take 6 to
12 months credits of course work in
informatics
• Category III- offer individual courses in
nursing informatics at both the graduate and
undergraduate level.
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22. Informal education
• Networking through professional
organizations
• Keeping abreast of literature by
Reading journals
Professional conferences
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24. Certification:
American Nurses Credentialing Center
(ANCC) offers certification:
• Possess active registered nursing license
• B.Sc (N) or higher Nursing degree
• Have practiced at least 2 years
• Have earned 20 contact hours of continuing
education credit.
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26. TECHNICAL COMPETENCIES
Technical competencies are related to the actual
psychomotor use of computers and other technological
equipment. Specific nursing informatics competencies
include the ability to use selected applications in a
comfortable and knowledgeable way. It is important
that nurses feel confident in their use of computers and
software in the practice setting, especially at the
bedside, in order to be able to attend to the client at the
same time.
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27. TECHNICAL COMPETENCIES
•Word processing
•Keyboarding
•Spreadsheets
•Presentation Graphics
•Databases
•Desktop Publishing
•Periphereals (printers,
CD-ROMS, DVD)
•World Wide Web
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•
•
•
E-mail programs
Expert data systems
Multimedia
Telecommunication
devices
• Nursing information
systems
• Hospital information system
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28. UTILITY COMPETENCIES
Utility competencies are related to the process of using
computers and other technological equipment within nursing
practice, education, research and administration. Specific
nursing informatics competencies include the process of
applying evidenced based practice, critical
thinking, and accountability in the use of selected applications
in a comfortable and knowledgeable way
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29. LEADERSHIP COMPETENCIES
Leadership competencies are related to the ethical
and management issues related to using computers
and other technological equipment within nursing
practice, education, research and administration.
Specific nursing informatics competencies include
the process of applying accountability, client
privacy and confidentiality and quality assurance in
documentation in the use of selected applications in
a comfortable and knowledgeable way
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30. NI Leadership Role
•
•
•
•
•
•
•
Evidence-Based Practice
Computer literacy skills
Information literacy skills
Project Management skills
Change Management skills
Process Management skills
Information management and
communication
– Data analysis
– Trending & forecasting
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• Resource Planning, Utilization
& Evaluation
– Technology Assessment
• Administration
• Safety & quality
• Make judgments based on data
trends & patterns
• Consultant
• Innovator
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31. Nursing Informatics – Future
• Ubiquitous computing is becoming a reality and the continued
innovation and miniaturization of technology is evident.
Consequently partnering between nurses in all specialties and
new technologies is becoming imperative
• The speed of information transfer and the increasing availability
of communication technologies will impact nurses and
informatics nurse specialists in the future, making nursing
practice and NI, in particular, more international in practices with
world-wide standards, competencies and curricula
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32. Future of Nursing Informatics
• Acute care
outpatient care
Home care
• Need knowledgeable practitioners to investigate, implement
and use automation
• Practitioners will be hired not so much for their knowledge of
skill as for their ability to handle information to make decision
that produce cost effective results.
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33. Future of Nursing Informatics
• Emerging roles
– Entrepreneurs, Product Developers, Web design,
Independent Consultants
• Challenges
– Integration of data—duplication often
– Inability to access data for decision making
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35. Development of modern
computing
• Phase I- Main frame era
many people share one computer
• Phase II- PC era
one person to one computer
• Phase III1. Ubiquitous computing
many computers to each person
Matsushita of Japan developed a prototype toilet that includes
online health monitoring system.
2. Internet
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36. OFFICE AUTOMATION
• Nursing office automation is the integrated
electronic technology distributed throughout
the Nursing administrative office.
• Affects the filing and retrieval of documents,
text processing, telephone communication and
informal meetings.
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37. OFFICE AUTOMATION…
• Word processing
Typed material is entered onto some form of
magnetic media. The equipment has the capability of
easily moving sentences, paragraphs or entire page to
different part of the document. The document can be
processed against automatic spelling and grammar
checker program. Data can be stored and retrieved for
further revision
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38. OFFICE AUTOMATION…
• Electronic filing
With electronic filing system it is possible to
search for documents by keywords, titles,
originators name or date of preparation.
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39. OFFICE AUTOMATION…
• Electronic document distribution(EDD)
Used for transmitting cash reports, draft of
contracts,
questionnaires
routine
correspondence and other administrative
documents.
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40. OFFICE AUTOMATION…
• Electronic mail
It is unofficial electronic communication
among individuals or office. It replaces several
telephone calls that would be required to
impart the same message.
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41. Electronic Health Record (EHR)
…
• a longitudinal electronic record of patient health
information generated by one or more encounters in
any care delivery setting. Included in this information
are patient demographics, progress notes, problems,
medications, vital signs, past medical history,
immunizations, laboratory data and radiology reports.
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42. EHRs….
• The EHR has the ability to generate a complete record
of a clinical patient encounter, as well as supporting
other care-related activities directly or indirectly via
interface – including evidence-based decision support,
quality management, and outcomes reporting.
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43. E-health
• E-health is a client-centered World Wide
Web-based network where clients and
health care providers collaborate
through ICT mediums to research, seek,
manage, deliver, refer, arrange, and
consult with others about health related
information and concerns
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44. Nursing Roles in E-health
• health advisors
• Internet guides to help clients select reliable information
resources
• support group liaisons
• web information providers
• Nurses need to be involved in the design and
implementation of E-health portals and programs that
provide the best possible experience for health care clients.
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45. Tele-nursing
• Telenursing
is the branch of
telehealth that
involves actual
nursing and client
interaction through
the medium of
information
technology
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46. Benefits of Telenursing
• Nurses
can actually view healing wounds, can
access physiological monitoring equipment to
measure physical indicators such as vital signs
and provide routine assessment and follow-up
care without the client having to travel to the
health care agency for an appointment.
• New technologies have added a visual
component to the interactions that augments
the historic audio exchange.
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49. COMPUTERIZED
DOCUMENTATION SYSTEM
1. Auditing
Computers are making it possible to audit
records on an ongoing basis and provide
feedback to care providers on the
completeness of their documentation
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50. COMPUTERIZED DOCUMENTATION
SYSTEM cont’d
2. Billing systems
Entering both patient information and a
provider password into a computer inorder to
access supplies or medications.
This means no items can be taken without
proper authorization and expenses can be
attributed to the appropriate patient.
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51. COMPUTERIZED DOCUMENTATION
SYSTEM cont’d
3. Patient information retrieval
Results of lab and diagnostic tests have
been posted to computer records, made rapidly
available to those who need it
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52. COMPUTERIZED DOCUMENTATION
SYSTEM cont’d
4. Order entry
a.Entry of physicians order, lab tests,
diagnostic tests and therapies is recorded
b. eliminate source of error such as
illegible handwriting, mistakes regarding
abbrevation, and confusion over spelling of
similar drug names.
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53. COMPUTERIZED DOCUMENTATION
SYSTEM cont’d
5. Nursing data entry
Many long term care facilities have nurses
complete assessment forms such as minimum
data set (MDS) and they have a data entry
person in medical records enter the data in
order to facilitate the computerized billing
process
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54. COMPUTERIZED DOCUMENTATION
SYSTEM cont’d
6.
Computerized medication administration
system
computerization of all medication records
along with bar coding of the medications and
patient identification bands.
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55. COMPUTERIZED DOCUMENTATION
SYSTEM cont’d
Other computer resources:
• Drug reference
• References regarding diagnostic tests
• Policy and procedure manual
• Medical center library reference
• Copies of journals
• bed management
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56. COMPUTERIZED DOCUMENTATION
SYSTEM cont’d
Other computer resources:
• Nursing service information
• To bleep
• Staff information
• Patient search
• Bill checking
• ECT list posting
• Admission recording
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57. COMPUTERIZED DOCUMENTATION
SYSTEM cont’d
Other computer resources:
• Entering transfer, discharge
• Salary
• Weekly institution news
• Staff meetings
• E-mail to the authorities
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58. COMPUTERIZED PATIENT
RECORDS
• Computerized patient record (CPR) or electronic patient
record include all information about an individual’s life time
health status and health care.
• Include information on
Allergies
History of illness and injury
Functional status
Diagnostic studies
Assessments
Orders
Consultant reports
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Treatment records
59. COMPUTERIZED PATIENT
RECORDS- cont’d
• Also includes wellness information
Immunization history
Behavioral data
Environmental information
Demographics
Health insurance
Administrative data for care delivery processes
Legal data such as consents
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60. COMPUTERIZED PATIENT
RECORDS-cont’d
1. Data capture:
• Refers to the collection and entry of data into
a computer system.
2. storage:
• Health data are distributed across multiple
systems at different sites.
• Needs common access protocols, retention
schedule and universal identification.
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61. COMPUTERIZED PATIENT
RECORDS- cont’d
3. Information Processing:
• Computer processing functions provide for effective
retrieval and processing of data into useful
information.
• These include decision support tool such as alerts and
alarms for drug interactions, allergies and abnormal
lab results.
• Reminders can be provided for administration,
medication administration
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62. COMPUTERIZED PATIENT
RECORDS-cont’d
4. Information communication:
it refers to the interoperability of systems and
linkages for exchange of data across disparate
systems.
5. Security:
ensures security as only authorized users with
legitimate uses have access to health
information
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63. COMPUTERIZED PATIENT
RECORDS-cont’d
6. Information presentation:
authorized care givers should have the
information they need in their preferred
presentation form
Eg: nurses needs data in detail
blood donation centers need not need much
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64. Information resources through
Internet
1. E-mail access:
E- mail allows to send and receive messages
rapidly around the world.
Specific names
.gov- governmental agencies
.edu- educational institutions
.com- commercial companies
.org- non profit organizations
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65. Information resources through
Internet cont’d
• Uses of E-mail:
1.Contact experts in the field
2.Ask specific questions of manufactures
regarding the use of their products
3.Seek answers to questions from Governmental
agencies
4.Share information with other health care
professionals
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66. Information resources through
Internet-cont’d
• Group discussion online:
1.It is a means for many individuals to send and
receive messages from a large number of
people with a similar interest.
2.Types:
• Listserv
• newsgroup
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67. Information resources through
Internet-cont’d
• World wide web:
it is a use of the Internet for the connection of
computers that all use a common protocol for
information exchange.
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68. COMPUTER ASSISTANCE
•
•
•
•
Maintenance of health records
Health security card
Use of ROBOTS
Reduce error and give certitude to the clinical planning process
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69. VIDEOCONFERENCING AND
WEB BASED CONFERENCING
• Helps to discuss the health problems of community
people who cant get access to tertiary hospitals
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70. Uses of Computer in
Hospital and Community
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71. PHARMACY ORDER MANUAL PROCESS
Physician writes order
Nurse validates
Secretary completes paper work
Nurse corrects
Nurse contactPhysician
Secretary sends to pharmacy
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73. Data Management
• Workload statistics
• Performance monitoring
• Performance Improvement projects
– Identification of problem areas
– Before & After data
• Regulatory compliance
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74. Data Management
•
•
•
•
How many new orders written on Ward X in a day?
How many medications given on Ward X in a week?
Show me all restraint orders for the past month
List patients in the hospital for >24 hours without a
VANOD skin assessment
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75. Education
Un
si
S p li tt in g ta b le ts
p
nu
a
Cle
e
os
th
o
xt
te
rs!
rde
not
es
Hold Orders
Q72h o
rd
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d
St
ers
tic
o
bi
ti
NURSING INFORMATICS
An
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o
tes
a
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76. How are Presence & Caring Conveyed?
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78. Clinician’s Access to Paper Record
•Attending Physician
•Nursing
•Consulting Physician(s)
•Respiratory Care
•Case Management
•Nutritional Services
•Risk Management
•IV Team
•Patient Financial Services
•Infection Control
•Wound Management
•Pastoral Care
•Clinical Process
Improvement
•Cardiology
•PT/OT/Speech
•Others
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PATIENT
CHART
NURSING INFORMATICS
BARRIERS
• Record must be on unit
• All clinicians and support
personnel must walk to
location of chart
• One person can access the
chart at a time
• Legibility of chart input
• Timely filing of data results
into chart
• Finding clipboard for most
current information
78
79. Clinician’s Access to Online Record
�Attending Physician
�Nursing
�Consulting Physician(s)
�Respiratory Care
�Case Management
�Nutritional Services
�Risk Management
�IV Team
�Patient Financial Services
�Infection Control
�Wound Management
�Pastoral Care
�Clinical Process
Improvement
�Cardiology
�PT/OT/Speech
�Others
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ELECTRONIC
PATIENT
DATA
NURSING INFORMATICS
BARRIERS:
• Systems Availability
• User Acceptance
79
80. BENEFITS
• Integrated Hemodynamic Monitors (Vital Signs) with
EMR
•Vital signs are automatically updated to the patient
• Eliminates paper documentation and accurately
captures patient information at the point of care
• Devices are fixed in the patient room or mobile on
COWs (Computers on Wheels)
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81. BENEFITS….
• Hand-held Devices for Data Collection & Input
• Assist with obtaining, verifying, and communicating
data
•Cardiology, Transplant, and other clinically significant
data can be entered directly online
• Eliminates the need for bulky data collection sheets
• Enhances the ability for version control of data entry
documents
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82. BENEFITS….
• Online Fully Integrated Medication
•Administration Record
•Significant time reduction associated to documenting
medications
• Significant time reduction associated with
transcription of medications to paper MAR
•Decreased transcription errors
•Increased patient safety
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84. BENEFITS….
• Online and Integrated Rules and Alerts (Workflow)
• Drug-allergy alerts based on order entry functionality
• Drug-drug interaction alerts
• Alerts for abnormal lab values and vital signs
•Alerts for new orders
• Alerts for order renewals
• Alerts for scheduled patient events
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85. BENEFITS….
•CPOE – Computerized Provider Order Entry
• Nurses no longer struggle to read physician
handwriting
•Reduces verbal orders
• All providers can enter orders directly online
• Integrated rules and alerts
•Integrated allergy check
• Decreases chances for transcription error
• Reduces delays in patient care
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86. BENEFITS….
•Bar Code Technology
•Barcodes on patient bands and medication packaging helps to
double check that the right medication is being given to the right
patient at the right time
•System alerts the nurse immediately if any inconsistencies or
potential problems exist
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87. BENEFITS….
• Health information technologies help patient
to know more about their health status.
• Patient can inform their health condition to
therapist through mail.
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88. Monitoring of programmes in
community
Health
Information
System
(HIS)
facilitates effective monitoring of programmes.
Eg; In Brazil the National AIDS control
programme of the federal Government is
linked with the AIDS control programmes of
Brazil’s 27 states and 150 municipalities
through computer based information system.
(SICLOM)
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89. National Rural Health
Mission( NRHM)
The Accredited Social Health Activist
(ASHA)- in each of the 6 lakh villages of the
country so that the medical needs of the people
living in remote areas could be taken care of.
ASHA would be connected with a telephone
as well as a computer with the rest of the
facilities in the public health care chain.
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90. Primary health center
• Designed to lessen the paperwork
responsibility, get better data accuracy,
and facilitate village health worker to
provide timely care and information to the
rural and semiurban population.
• 2 projects were disigned for this.
1.Health Management Research Institute
2.Emergency Management Research
Institute
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91. Health management
Research Institute(HMRI)
• HMRI in association with Govermnent of
India (GOI) and satyam foundation ,
hyderabad provides health care services on
call over a toll free no ‘104’ which is available
round the clock
• Services include medical advice, counselling,
information , tele medicine, tele monitoring
and hospital management.
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92. HMRI…..
• People can have access to the details of
dispensaries, diagnostic centres, medical shops
and hospital in the locality, medical colleges,
rehabilitation canters.
• Field workers engaged in monitoring of
epidemics, outbreaks and analyzing the
morbidity trend of their village contact this
response center(104) and give information to
the Integrated disease surveillance programme
(IDSP)
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93. Emergency Management
research institute(EMRI)
• Satyam computers, with the collaboration of
Government is providing emergency response
services which enables distress calls.
• It reaches out to rescue people involved in
critical accidents and emergencies.
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94. Other uses in community
• Community information
• Monthly report (no of birth, immunization,
communicable disease, deaths, delivery)
• Planning for programme
• Planning for mobile clinic with regard to the
information
• Vital statistics
• Hospital statistics
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95. Other uses in community
•
•
•
•
•
Community mapping
Research
Epidemic outbreak
Demographic characteristics of population
Mass education
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97. Privacy, Security,
Confidentiality
• Protected
by Policies & Procedures
• Security refers to technological, organizational, or
administrative processes designed to protect data
systems from unwarranted access, disclosures,
modification, or destruction.
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98. ETHICAL IMPLICATIONS
1. CONFIDENTIALITY:
Develop policies and procedures to ensure confidentiality
Limit the time that information is left on the screen
Placement of computer terminals
A mechanism to determine which individuals are requesting
sensitive information
Creating passwords- change routinely
Create level of access
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99. ETHICAL IMPLICATIONS contd
2. EMPLOYEE ACCESS
Policies and procedures regarding
a. How employee can obtain accessibility
b. For what reason they wish to access accessibility
c. What information can be accessed
d. What information is confidential and has limited access
The access code should not be in alphabetical or numerical
order
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100. ETHICAL IMPLICATIONS contd
3. PATIENT PRIVACY:
Privacy of information obtained from the
patient and family members must be protected
from those may “ abuse” such information
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101. ETHICAL IMPLICATIONS contd
4. ACCURACY OF DATA INPUT:
• Policies and procedures regarding entry of
information into computerized records
accurately and in timely manner.
• Orientation and training programme must be
developed.
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102. ETHICAL IMPLICATIONS contd
5. PATIENT’S RIGHT TO A COPY OF THE
MEDICAL RECORD:
• Policies and procedures regarding when a
patient or patient’s attorney can actively obtain
a copy of computerized chart
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103. ETHICAL CONCEPTS:
• Know the importance of confidentiality
• Know about the laws regarding computer
information
• Be concerned about what data is collected and
how the data is used
• Be concerned about the dehumanisation of
patient care
• Know about ethical/ legal issues
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104. ROLE OF NURSE MANAGER
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105. Evaluation of information found
on the Net
1. PURPOSE
What is the authors purpose in developing the
site?
Are the authors objective clear?
Many people will develop website as a hobby
There should be congruence between author
purpose and ours
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106. Evaluation of information found
on the Net……
2. LINKS:
Evaluate the links at the site. Are they working?
Do they link to reliable sites?
Check for dead links
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107. Evaluation of information found
on the Net…..
3. EDITORIAL
Is the information in the site accurate,
comprehensive and current?
Who is the consumer of the site?
Is the information presented in an appropriate
format for the intended audience?
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108. Evaluation of information found
on the Net….
4. AUTHOR
Who is the author of the site?
Does he has appropriate credentials?
Is the author clearly identified by name and is
contact information provided?
Check for webmaster and author
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109. Evaluation of information found
on the Net….
5. SITE
Is the site easy to navigate?
Does it download quickly?
6. ETHICAL
Is there contact information for site developer
and author?
Is there full disclosure of who the author is
and the purpose of the site?
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110. Evaluation of information found
on the Net….
6. DATE:
When was the site last updated?
Does the information need to be updated
regularly?
Be concerned with sites that have not been
updated within 12 to 18 months.
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111. Examine and Describe:
• Target
environment
• Current Situation
• Projected Situation
• New & Emerging
Technologies and Resources
• Key Information Sources
• Emerging Issues
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112. Implementation tips
1.
•
•
•
1.
2.
3.
4.
Be prepared to implement change within change
Personnel change
Organizational change
Technological change
Requires economic justification
All groups will demand something immediately
Be prepared to violate some classical principles now and
then
Develop and implement in phases
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113. Implementation tips….
6. Anticipate that software will be
a problem area
• Buy donot build office automation software
• Do not be a testing ground for new software
7. Be aware of automation paradox
• Demand will exceed supply
• Full automation capabilities will not be used
8. Biggest challenge is people challenge
9. There will be always something you didn’t think of
10. Establish standard software and communication protocol
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114. Ergonomics….
comes from the Latin ergos (to
work) and nomos (knowledge).
• the science of using knowledge of
work activities and the human
body’s limitations to structuring
work environments, or
"fitting the work to the
worker".
•
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115. Ergonomic Assessment
• Is
your computer workstation safe and
ergonomically situated?
• If not, what do you need to change to
work in an ergonomically supported
environment?
• What about using PDAs?
• Or Laptops?
• Or Cell Phones?
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116. PPE for Computers
•Personal Protective Equipment
–Antivirals
–Firewalls
–Operating System Updates
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117. Implications
Evaluation of the organization’s current Informatics infrastructure should be
conducted
– Annually
– Anytime upgrades are made
– As patient populations served change
– As care delivery programs change
Nursing leadership must be sensitive to the importance of planning
for adequate budgetary resources (personnel, hardware and
software)
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118. Barriers
•
•
•
•
•
Expensive
Training to staff
Initial resistance from staff
Adoption is time consuming process
Aged and outdated equipment calls for
replacement due to technological changes
which adds to the cost
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