nursing informatics.pptx computer in nursing

informatics in nursing

1. Nursing Informatics

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

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

4. Definition of Nursing Informatics (2) i n f o r m a t i c s is u s ing technology, and professional Nursing r e s ea rc h , manage nursing data, information, expe r i enc e to an d kn o w le d g e t o i m p r o ve p r ac t i c e an d d eli v er better health care.

5. Nursing Informatics R ING INFORMAT

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

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 .

8. Historical develpoment… T e l e m ed i c i ne b eca m e po s s i b l e an d wa s 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.

9. All Nurses Must Possess computer skills Be ab l e t o u s e ap pli ca t i o n s, and Kno w ho w t o m an a ge information and knowledge

10. Why is it important? Informatics to use enables in f o r m a t i o n nur s es and c o mm un i cat i o n s t echno l o g ies in the:  collection of data,  use of information  gene r a t i o n o f kn o w ledge to support nursing practice Nursing T ec h no l o g y

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.

12. Functional Areas of Nursing I n f o r m a t i c s : A N A S cop e an d Standards of Practice Administration, leadership and management Analysis Compliance & integrity management Consultation Coordination, facilitation, & integration Development Educational & professional development Policy development & advocacy Research evaluation

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”

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

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

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. of n e w develop m e nts c o ntinuing education – Practitioners update themselves through journals, conferences, sessions. .

17. Disaster Nursing Informatics

18. The Benefits of Nursing Informatics In the practice of professional nursing In the delivery of patient care in the healthcare continuum

19. The Benefits of Nursing Informaticists Benefits for nurses and the interdisciplinary team: Support for their mission to deliver high quality, evidence-based care Support for better service by facilitating true interdisciplinary care Promotes improvement in key relationships with physicians, peers, interdisciplinary care team members, patients and families

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

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.

22. Informal education Networking through professional organizations Keeping abreast of literature by  Reading journals  Professional conferences

23. Frist Nursing Informatics Center

24. C e r t i fi c a t i o n :  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.

25. NEEDED COMPETENCIES

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.

27. TECHNICAL COMPETENCIES • • • • • • E-mail programs Expert data systems Multimedia T e l e co m m unication devices Nursing information systems Hospital information system Word processing Keyboarding Spreadsheets Presentation Graphics Databases Desktop Publishing Periphereals (printers, CD-ROMS, DVD) World Wide Web

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

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

30. 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 Resource Planning, Utilization & Evaluation – Technology Assessment Administration Safety & quality Make judgments based on data trends & patterns Consultant Innovator NI Leadership Role

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

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.

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

34. C O MP U TE R

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 III- Ubiquitous computing many computers to each person Matsushita of Japan developed a prototype toilet that includes online health monitoring system. Internet

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 .

37. 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 OFFICE AUTOMATION…

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 .

39. OFFICE AUTOMATION… Electronic document distribution(EDD) Used for transmitting cash reports, draft of q ue s t i onna i r e s an d o t h er ro u tine a d mi n i s t r a ti ve contracts, c orr e sp onden ce documents.

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 .

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.

42. E H R s … . 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.

43. E - hea l t h 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

44. Nursing Roles in E-health health advisors Internet guides to help clients select reliable information resources support group liaisons web information providers N u r s es ne e d implementation to be involved in the de s i gn and of E-health po r tals and progra m s that provide the best possible experience for health care clients.

45. Tele-nursing Telenursing is the branch of telehealth that involves actual nursing and client interaction through the medium of information technology

46. Benefits of Tele- nursing 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.

47. Interaction with other health care professionals

48. Computerized documentation system

49. COMPUTERIZED DOCUMENTATION SYSTEM 1. Auditing C o m pu ter s a r e m ak i n g i t p o ss ibl e t o aud it records f e edb a c k o n a n on g o i ng ba s i s a nd p r ov ide t o ca r e p ro v i d e rs o n the completeness of their documentation

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.

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

52. COMPUTERIZED DOCUMENTATION SYSTEM cont’d Order entry Entry of physicians or de r , lab t e s t s, diagnostic tests and therapies is recorded b. e li m in a te s ou r c e o f e r r o r s uc h a s illegible handwriting, mistakes regarding abbrevation, and confusion over spelling of similar drug names.

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

54. COMPUTERIZED DOCUMENTATION SYSTEM cont’d 6 . C o m p ut e ri z e d m e di ca t i o n a d m i n i s t r a tion system computerization of all medication records along with bar coding of the medications and patient identification bands.

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

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

57. COMPUTERIZED DOCUMENTATION SYSTEM cont’d Other computer resources: Entering transfer, discharge Salary Weekly institution news Staff meetings E-mail to the authorities

58. COMPUTERIZED PATIENT RECORDS  Treatment 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 58 Allergies History of illness and injury Functional status Diagnostic studies Assessments Orders Consultant repor t

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

60. COMPUTERIZED PATIENT RECORDS-cont’d 1. Data capture: Refers to the collection and entry of data into a computer system. 2 . storage: H ea lt h d a t a a re d i s tri but e d a cr oss m u l t i p le systems at different sites. N eed s c o m m on ac c e ss p r o t o c ols, r e te n ti on schedule and universal identification.

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

62. COMPUTERIZED PATIENT RECORDS-cont’d Information communication: it refers to the interoperability of systems and linkages for exchange of data across disparate systems. Security: ensures security as only authorized users with legitimate uses have access to health information

63. COMPUTERIZED PATIENT RECORDS-cont’d 6 . Information presentation: authorized i n f o r m a t i on care th e y g iv e rs s hou l d hav e t he nee d i n t h e i r p r e f e rred presentation form Eg: nurses needs data in detail blood donation centers need not need much

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

65. Information resources through Internet cont’d Uses of E-mail: Contact experts in the field A sk s pec i f i c que s ti o n s o f m a n u f a ct ur e s regarding the use of their products Seek answers to questions from Governmental agencies S h a re i n f o rm ati on w i t h o t h e r he alt h ca re professionals

66. Information resources through Internet-cont’d Group discussion online: It is a means for many individuals to send and receive messages from a large number of people with a similar interest. Types: Listserv newsgroup

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.

68. COMPUTER ASSISTANCE • • • • Maintenance of health records Health security card Use of ROBOTS Reduce error and give certitude to the clinical planning process

69. VIDEOCONFERENCING AND WEB BASED CONFERENCING H e l p s t o di scu s s the h e a lth p ro bl e m s o f c o mm u n ity people who cant get access to tertiary hospitals

70. Uses of Computer in Hospital and Community

71. Physician writes order Secretary completes paper work Nurse validates Nurse corrects Nurse contactPhysician Secretary sends to pharmacy PHARMACY ORDER MANUAL PROCESS

72. PHARMACY ORDER, AUTOMATED PROCESS Physician enters order in computer pharmacy receives order

73. Workload statistics Performance monitoring Performance Improvement projects Identification of problem areas Before & After data Regulatory compliance Data Management

74. 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 Data Management

75. E d uca t i o n C lea n up thos e te xt o rder s! Unsig ned n otes Q7 2h orders Hold Orders Splittin g tablets An ti biot ic Sto p D ate s

76. How are Presence & Caring Conveyed ?

77. Clinical Reasoning Software 77

78. Clinician’s Access to Paper Record 78 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 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 PA TI ENT CHART SANGEETHA ANTOE NURSING INFORMATICS

79. Clinician’s Access to Online Record 79 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 BARRIERS: Systems Availability User Acceptance ELECTRONIC PATIENT DATA SANGEETHA ANTOE NURSING INFORMATICS

80. B EN E F I T S 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)

81. B EN E F I TS … . 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

82. B EN E F I TS … . 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

83. Medication Administration Record bef o r e 8 3 a fter

84. B EN E F I TS … . 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

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

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 S y stem ale r ts the n u r se i mm ediately if any inconsist e n c i e s or potential problems exist

87. B EN E F I TS … . H ea lt h i n f o r m a t i on t e c h no lo g i e s he l p p a ti en t to know more about their health status. Pa t i en t ca n i n f o rm t h e i r he alt h con dition t o therapist through mail .

88. Eg; In Brazil the National A IDS co ntr o l programme of the federal G ove r n m en t i s Monitoring of programmes in community H ea l t h I n f o r m a t i o n S y s t e m ( H IS) facilitates effective monitoring of programmes. linked with the AIDS control programmes of Brazil’s 27 states and 150 municipalities through computer based information system. (SICLOM)

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.

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

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 .

92. H M RI … .. 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)

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.

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

95. Other uses in community Community mapping Research Epidemic outbreak Demographic characteristics of population Mass education

96. E t h i cs

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.

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

99. 2 . EMPLOYEE ACCESS  Policies and procedures regarding ETHICAL IMPLICATIONS contd How employee can obtain accessibility For what reason they wish to access accessibility What information can be accessed What information is confidential and has limited access  The access code should not be in alphabetical or numerical order

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

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.

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

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

104. ROLE OF NURSE MANAGER

105. Evaluation of information found on the Net 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

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

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?

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

109. Evaluation of information found on the Net…. SITE  Is the site easy to navigate?  Does it download quickly? 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?

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. 110

111. Examine and Describe: Target environment Current Situation Projected Situation New & Emerging Technologies and Resources Key Information Sources Emerging Issues

112. Implementation tips 1. 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

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 Biggest challenge is people challenge There will be always something you didn’t think of Establish standard software and communication protocol

114. Ergonomics…. 114 co m es f r o m t he Latin ergos (to work) and nomos (knowledge). the science of using knowledge of the hu m a n st r u c t uring work activities and bod y ’s l i m itations to work environments, or "fitting the work to the worker". SANGEETHA ANTOE NURSING INFORMATICS

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?

116. PPE for Computers Personal Protective Equipment –Antivirals –Firewalls –Operating System Updates

117. Impl i ca t i o ns 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)

118. B a r r i e rs 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

119. “ Innovation distinguishes between a leader and a follower.” - Steve Jobs conclusion

120. 120

121. 121 THANK YOU NURSING INFORMATICS