Nursing Informatics: History and Basics

• Nursing informatics involves the use of data, information, and knowledge to support nursing practice

What is Informatics?

• Informatics is the science of information and all its aspects, including its storage, processing, communication, and use
• The term was coined as the name of a software company
• Walter Bauer coined the term 'informatics'
• The term comes from the French word "informatique"
• Healthcare is a major user of informatics

Terms to Understand

• Information Science is the study of processing information
• Information System includes hardware and software
• Information Technology is a general term for processing information via computers
• Information Management is the process of turning data into information and knowledge
• Informatics is the study of information processing and computers

What is Nursing Informatics?

• Nursing informatics combines computer science, information science, and nursing science to manage and process nursing data, information, and knowledge
• Nursing informatics applies computer technology to all areas of nursing: service, education, and research (Scholes and barber, 1980)
• Nursing informatics is concerned with nurses utilizing computer technology and managing information, which facilitates and improves nursing knowledge (McCormick & Saba)
• Nursing informatics integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice (American Nurses Association, 2008)
• Nursing informatics integrates nursing, its data/information, its knowledge and their application, with information and communication technology to promote the health of families and communities worldwide (American Medical Informatics Association AMIA)

Role of computers in 1960

• Computers handled administrative tasks
• Healthcare information technology (HIT) and electronic health record (EHR) systems were developed

Healthcare Information Technology

• Refers to technology used to capture, process, and analyze healthcare information
• Computerization impacts all aspects of healthcare delivery
• Refers to the use of technology to manage and improve healthcare services
• Supports the provision and documentation of patient care
• Used to educate healthcare providers
• Supports scientific research
• Assists with administration of healthcare services
• Impacts reimbursement for patient care
• Raises legal and ethical implications
• Impacts safety and quality issues

Computers in Modern Nursing

• Computers manage patient information
• They monitor quality and evaluate outcomes
• Help nurses in planning, budgeting, and policy-making
• Provide real-time plans of care
• Used to support nursing research
• Enhances education

Historical Perspective of Nursing and Computers

• Computers were introduced into nursing over 40 years ago
• Milestones made include advancements in computer and information technology, the increasing need for nursing data, and the development of nursing applications

Prior to 1960s

• There were few national and international experts
• Gordon Moore created Moore's Law
• The first use of computers in healthcare was in the 1950s
• Computers were used for basic office, administrative and financial functions
• Computers used punch cards to store data, with teletypewriters for output

1960s

• Computer technology use explored in healthcare
• Studies conducted on effective use of computer technology in healthcare
• Nurses became super users of computers due to a new ICU proliferation

1970's

• Hospitals began developing computer-based information systems where nurses were involved in implementing HIT systems
• Computers emerged in public health, home health, and education between the 1960s-1970s
• Birth of the computerized teaching system, PLATO
• Nurses began to use point of care blood glucose monitors in 1970
• The North American Nursing Diagnosis Association (NANDA) were founded

1980s

• Nursing informatics became an integral part of healthcare
• Availability of PCs made technology more accessible
• A need evolved to use of nursing software
• Automated dispensing cabinets were introduced to reduce medication errors
• Mainframe HISS (Healthcare Information Systems) emerged with nursing subsystems
• Nurses presented at multidisciplinary conferences and formed their own working groups within HIT organizations
• There was a focus on what was unique about nursing related to informatics
• The first edition of "Essentials of Computers for Nurses, 1986" was used in educational nursing courses and workshops

1990s

• Large healthcare delivery systems emerged
• Computing applications became more affordable
• The ANA (American Nurses Association) recognized nursing informatics as a specialty and informatics grew as an area of expertise in 1992
• HIPAA (Health Insurance Portability and Accountability Act) of 1996 set a foundation for electronic health records (EHRs)
• Standards were developed by the ANA (American Nurses Association) to evaluate nursing information systems
• The general public gained internet access and access to healthcare information
• Internet access to information and databases became integrated into computer systems
• Computer PCs(hardware) became more affordable as well as smaller PC notebooks
• Internet integrated into a mainstream social milieu, (social environment)

2000s

• Healthcare information grew more digitalized and newer technologies emerged
• Widespread adoption of interoperable EHRS (electronic health records)
• Several Key barcode medication administration systems and radiofrequency (wireless) in the barcode system equipment for patient safety, were mobile in order to broaden mobile access to information
• Barcode medication administration systems (wireless) was implemented
• Hospitals became "paperless" in the late 2000's
• Internet protocol began with verbal and remote database EHR
• Mobile wireless devices were built within hospitals to allow for more patient bedside access

2010's

• HITECH Act (Health Information Technology for Economic and Clinical Health Act) (2009) helped promote Meaningful Use program development
• (MU) Meaningful Use was used as a program in stages:
• MU stage 1 (2011-2012) focus on CPOE (computerized physician order entry devices)
• MU stage 2 (2013-2015) emphasized use of quality indicators, patients safety along with electronic data collection
• MU stage 3 Focused on quality performance of healthcare as a whole

Electronic Health Record (EHR) Systems

• A digital version of a patient's paper chart that has current health information.
• It can be shared across different healthcare settings

The Nurse as a Knowledge worker

• Registered Nurses use data, information, and knowledge
• Healthcare uses information management to support Nurses
• Maintaining good quality data ensures no errors
• Nurses rely on their knowledge and need the means to access proper information to provide adequate safe patient care
• Technology can support evidence-based practices
• Nurses use data and information with a vast number of available sources

Nursing Careers in Nursing Informatics

• Nurse Informaticist - Optimizing healthcare technology to improve patient care and clinical workflows
• Clinical Informatics Specialist - Serves as a liaison to clinical staff and IT (Information Technology) teams
• Health Informatics Consultant - Offers advice to healthcare organizations to improve existing processes or implementing new technology
• Nursing Data Analyst - Analyzes trends and help with patient outcomes
• Clinical Applications Specialist - Implement for healthcare providers
• Chief Nursing Informatics Officer (CNIO) -integrating Nursing practice with technology by position
• Telehealth Nurse Specialist - helps people be enabled to access care through integration and the utilization of technology
• Nurse Educator in informatics - Nursing informatics through clinical settings