Essentials of Nursing Informatics PDF

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Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. 20-02-2015 19:14:41 Essentials of Informatics Nursing FM.indd 1  Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. Notice Medicine is an ever-changing science. As new research and clinical expe- rience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide informa- tion that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the pub- lisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsi- bility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to con- firm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the con- traindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. FM.indd 2 20-02-2015 19:14:42  Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. Essentials of Nursing Informatics SIXTH EDITION Virginia K. Saba, EdD, RN, FAAN, FACMI CEO and President SabaCare, Inc. Arlington, Virginia Distinguished Scholar, Emeritus Georgetown University Washington, District of Columbia Professor, Adjunct Uniformed Services University Bethesda, Maryland Kathleen A. McCormick, PhD, RN, FAAN, FACMI, FHIMSS Principal/Owner SciMind, LLC North Potomac, Maryland New York Chicago San Francisco Athens London Madrid Mexico City Milan New Delhi Singapore Sydney Toronto FM.indd 3 20-02-2015 19:14:42  Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. Copyright © 2015 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher, with the exception that the program listings may be entered, stored, and executed in a computer system, but they may not be reproduced for publication. 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Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.  Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. CONTENTS Contributors ix Part 2 — System Life Cycle 161 Foreword 1 xvii Virginia K. Saba Foreword 2 xix Preface xxi 11 System Life Cycle: A Framework 163 Acknowledgments xxiii Marina Douglas and Marian Celli 12 System and Functional Testing 189 Part 1 — Nursing Informatics Theresa J. Settergren Technologies 1 13 System Life Cycle Tools 203 Jacqueline Ann Moss Denise D. Tyler 1 Historical Perspectives of Nursing 14 Healthcare Project Management 215 Informatics 3 Judy Murphy and Patricia C. Dykes Virginia K. Saba and Bonnie L. Westra Part 3 — Informatics Theory 2 Computer Hardware 23 Standards—Foundations of Nursing Mary L. McHugh Informatics 227 3 Advanced Hardware and mHealth 37 Virginia K. Saba Kathleen G. Charters and Patricia B. Wise 15 The Practice Specialty of Nursing 4 Computer Software 45 Informatics 229 Mary L. McHugh Kathleen M. Hunter and Carol J. Bickford 5 Open Source and Free Software 55 16 Nursing Informatics and Healthcare Policy 249 David J. Whitten Judy Murphy and Elizabeth (Liz) O. Johnson 6 Data and Data Processing 83 Part 4 — Nursing Informatics Irene Joos and Ramona Nelson Leadership 273 7 Health Data Standards: Development, Kathleen Smith Harmonization, and Interoperability 101 17 The Role of the Nurse Executive in Information Joyce Sensmeier Technology Decision-Making 275 8 Standardized Nursing Terminologies 115 Roy L. Simpson Nicholas R. Hardiker, Virginia K. Saba and 18 Establishing Nursing Informatics in Public Tae Youn Kim Policy 281 9 Human–Computer Interaction 131 Dana Alexander and Elizabeth Casey Halley Gregory L. Alexander 19 Communication Skills in Health IT, Building 10 Trustworthy Systems for Safe Strong Teams for Successful Health IT and Private Healthcare 145 Outcomes 293 Dixie B. Baker Elizabeth (Liz) O. Johnson v FM.indd 5 20-02-2015 19:14:42  vi C ontents Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. 20 Assessing the Vendors 309 32 Public Health Practice Applications 457 Mark D. Sugrue Judy D. Gibson, Janise Richards, Arunkumar Srinivasan and Derryl E. Block 21 Nurse Scheduling and Credentialing Systems 323 33 Informatics Solutions for Emergency Planning Karlene M. Kerfoot and Kathleen Smith and Response 471 Elizabeth (Betsy) Weiner and Capt. Lynn A. Slepski 22 Informatics and the Healthcare Industry 333 Amy J. Barton 34 Federal Healthcare Sector Nursing Informatics 485 Part 5 — Advanced Nursing Informatics in Capt. Margaret S. Beaubien, Murielle S. Beene, Practice 345 Christine Boltz, Lee Ann Harford, LTC Mike Ludwig, Gail E. Latimer Daniel F. Marsh, Joel L. Parker, COL Katherine Taylor Pearson and Capt. Stephanie J. Raps 23 Structuring Advanced Practice Knowledge: An Internet Resource for Education 35 Consumer/Patient Engagement and eHealth and Practice 347 Resources 499 Mary Ann Lavin, Eileen Healy Barbara B. Frink and Mary Lee Barron Part 6 — Nursing Informatics—Complex 24 Nursing Informatics in Retail Clinics 363 Applications 511 Frances (Fran) M. Spivak and Sandra Festa Ryan Kathleen A. McCormick 25 Care Delivery Across the Care Continuum: 36 Healthcare Analytics 513 Hospital–Community–Home 371 Kathleen C. Kimmel Charlotte A. Weaver and Laura Heermann 37 Planning, Design, and Implementation of Langford Information Technology in Complex 26 Foundation of a Nursing Plan of Care Healthcare Systems 525 Standard 385 Thomas R. Clancy Luann Whittenburg and Virginia K. Saba 38 The Quality Spectrum in Informatics 537 27 Computerized Provider Order Entry 401 Rosemary Kennedy, Heidi Bossley, Juliet Rubini and Emily B. Barey Beth B. Franklin 28 Physiological Monitoring and Device 39 Translation of Evidence into Nursing Interface 409 Practice 553 R. Renee Johnson-Smith Lynn McQueen, Heather Carter-Templeton and Kathleen A. McCormick 29 Health Information Technology: Striving to Improve Patient Safety 419 40 Improving Healthcare Quality and Patient Patricia P. Sengstack Outcomes Through the Integration of Evidence-Based Practice and Informatics 569 30 The Role of Technology in the Joanne M. Seasholtz and Bernadette Mazurek Melnyk Medication-Use Process 429 41 Incorporating Evidence: Use of Matthew C. Grissinger and Michelle M. Mandrack Computer-Based Clinical Decision 31 The Magnet Model 451 Support Systems for Health Professionals 583 Andrea Mazzoccoli and Susan H. Lundquist Margaret Ross Kraft and Ida M. Androwich FM.indd 6 20-02-2015 19:14:42  Contents vii Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. Part 7 — Educational Applications 591 Part 9 — Big Data Initiatives 705 Diane J. Skiba Kathleen A. McCormick 42 Nursing Curriculum Reform and 49 Genomics and Information Technology Healthcare Information for Personalized Health 707 Technology 593 Kathleen A. McCormick and Kathleen A. Calzone Eun-Shim Nahm and Marisa L. Wilson 50 Global eHealth and Informatics 727 43 The TIGER Initiative 609 Amy Coenen, Claudia C. Bartz and Martha K. Badger Michelle R. Troseth Part 10 — International Perspectives 739 44 Initiation and Management of Accessible, Susan K. Newbold Effective Online Learning 617 Patricia E. Allen, Khadija Bakrim, Darlene Lacy, 51 Nursing Informatics in Canada 741 Enola Boyd and Myrna L. Armstrong Lynn M. Nagle, Kathryn J. Hannah and Margaret Ann Kennedy 45 Social Media in the Connected Age: Impact on Healthcare Education and 52 Nursing Informatics in Europe 751 Practice 631 Kaija Saranto, Virpi Jylhä, Ulla-Mari Kinnunen and Diane J. Skiba, Sarah Knapfel Eija Kivekäs and Chanmi Lee 53 Pacific Rim Perspectives 777 46 A Paradigm Shift in Simulation: Evelyn J. S. Hovenga, Michelle L. L. Honey and Experiential Learning in Lucy A. Westbrooke Virtual Worlds 643 54 Nursing Informatics in Asia 801 Helen R. Connors and Judith J. Warren Hyeoun-Ae Park 55 Nursing Informatics in South America 817 Part 8 — Research Applications 661 Heimar de Fatima Marin Virginia K. Saba 56 Nursing Informatics in South Africa 827 Irene van Middelkoop and Susan Meyer 47 Computer Use in Nursing Research 663 Veronica D. Feeg and Theresa A. Rienzo Appendix A Overview of Clinical Care Classification System 833 48 Information Literacy and Computerized Virginia K. Saba and Luann Whittenburg Information Resources 687 Diane S. Pravikoff and June Levy Index 855 FM.indd 7 20-02-2015 19:14:42 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. This page intentionally left blank  Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. CONTRIBUTORS Kathleen A. McCormick, PhD, RN, FAAN, Diane J. Skiba, PhD, FACMI, FAAN FACMI, FHIMSS Professor and Informatics Specialty Principal/Owner Coordinator SciMind, LLC University of Colorado College of Nursing North Potomac, Maryland Aurora, Colorado Virginia K. Saba, EdD, RN, FAAN, FACMI Kathleen Smith, BSN, MScEd, RN-BC, FHIMSS CEO and President Managing Partner SabaCare, Inc. Informatics Consulting and Continuing Arlington, Virginia Education, LLC Distinguished Scholar, Emeritus Weeki Wachee, Florida Georgetown University Washington, DC FOREWORD CONTRIBUTORS Professor, Adjunct Uniformed Services University Kelly Aldrich, DNP, RN-BC Bethesda, Maryland Informatics Nurse Specialist Chief Nursing Informatics Officer and Assistant SECTION EDITORS/AUTHORS Vice President Hospital Corporation of America (HCA) Gail E. Latimer, MSN, RN, FACHE, FAAN Nashville, Tennessee Vice President and Chief Nursing Officer Siemens Medical Solutions, Inc. Jane D. Englebright, PhD, RN, USA Health Services CENP, FAAN Malvern, Pennsylvania Chief Nursing Officer, Patient Safety Officer, and Vice President, Clinical Services Group Jacqueline Ann Moss, PhD, RN, FAAN HCA Chair and Assistant Dean for Clinical Nashville, Tennessee Simulation and Technology School of Nursing John P. Glaser, PhD, FACMI, FCHIME, FHIMSS University of Alabama at Birmingham CEO, Siemens Health Services Birmingham, Alabama Siemens Healthcare Malvern, Pennsylvania Susan K. Newbold, PhD, RN-BC, FAAN, FHIMSS, CHTS-CP Gail E. Latimer, MSN, RN, FACHE, FAAN Owner Vice President and CNO, Siemens Health Services Newbold Consulting Siemens Healthcare Franklin, Tennessee Malvern, Pennsylvania ix FM.indd 9 20-02-2015 19:14:42  x C ontributors Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. Jonathan B. Perlin, MD, PhD, MSHA, Dixie B. Baker, PhD, MS, MS, BS FACP, FACMI Senior Partner President, Clinical Services Group Martin, Blanck and Associates Chief Medical Officer Redondo Beach, California Hospital Corporation of America (HCA) Nashville, Tennessee Khadija Bakrim, Ed D Instructional Designer AUTHORS AND CO-AUTHORS Texas Tech University Health Sciences Center School of Nursing Dana Alexander, MSN, RN, MBA, Lubbock, Texas FAAN, FHIMSS Vice President, Integrated Care Delivery & CNO Caradigm Emily B. Barey, MSN, RN Castle Rock, Colorado Director of Nursing Informatics Epic Gregory L. Alexander, PhD, MHA, MIS, RN Verona, Wisconsin Associate Professor University of Missouri Mary Lee Barron, PhD, APRN, FNP-BC, Sinclair School of Nursing FAANP Columbia, Missouri Associate Professor Southern Illinois University-Edwardsville Patricia E. Allen, Ed D, RN, CNE, ANEF, FAAN Edwardsville, Illinois Professor Texas Tech University Health Sciences Center Lubbock, Texas Amy J. Barton, PhD, RN, FAAN Professor and Associate Dean for Clinical and Ida M. Androwich, PhD, RN-BC-NI Community Affairs Professor and Director of Health Systems College of Nursing Management University of Colorado Loyola University Chicago Aurora, Colorado La Grange Park, Illinois Claudia C. Bartz, PhD, RN, FAAN Myrna L. Armstrong , EdD MS, BSN, ANEF, FAAN Coordinator, ICN eHealth Programme Nursing Consultant, Professor Emerita University of Wisconsin-Milwaukee Texas Tech University Health Sciences Center Milwaukee, Wisconsin School of Nursing Lubbock, Texas Capt. Margaret S. Beaubien, NC, USN, MSN, RN, Martha K. Badger, MSN, RN-BC, CPHIMS MS, CPHIMS Research Scientist Acting Deputy Director, HIT Knowledge-Based Nursing Department Deputy CIO Aurora Health Care Defense Health Agency Milwaukee, Wisconsin Falls Church, Virginia FM.indd 10 20-02-2015 19:14:42  Contributors xi Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. Murielle S. Beene, DNP, RN-BC, MBA, MPH, Kathleen G. Charters, PhD, RN, CPHIMS MS, PMP Nurse Consultant Chief Nursing Informatics Officer Defense Health Agency Department of Veterans Affairs Falls Church, Virginia Veterans Health Administration Office of Informatics and Analytics Health Informatics Thomas R. Clancy, PhD, MBA, RN, FAAN Office of the Chief Nursing Informatics Officer Clinical Professor and Assistant Dean, Partnerships, Washington, DC

 Practices, Professional Development Carol J. Bickford, PhD, RN-BC, CPHIMS School of Nursing Senior Policy Fellow University of Minnesota Department of Nursing Programs Minneapolis, Minnesota American Nurses Association Silver Spring, Maryland Amy Coenen, PhD, RN, FAAN Professor Derryl E. Block, PhD, RN, MPH University of Wisconsin-Milwaukee Dean, College of Health and Human Sciences College of Nursing Northern Illinois University Milwaukee, Wisconsin DeKalb, Illinois Director of International Classification for Nursing Christine Boltz, MA, MS, RN-BC, CPHIMS Practice Programme, International Council of Capt., NC, USN (Ret.)/Online Instructor Nurses Excelsior College, School of Nursing Geneva, Switzerland Alexandria, Virginia Helen R. Connors, PhD, RN, FAAN Heidi Bossley, MSN, MBA Professor Independent Healthcare Consultant University of Kansas School of Nursing and Center Alexandria, Virginia for Health Informatics Enola Boyd (Deceased), EdD, MS Kansas City, Kansas Texas Tech University Health Sciences Center Lubbock, Texas Marina Douglas, MS, BSN Kathleen A. Calzone, PhD, RN, APNG, FAAN

 Principal, Beacon Healthcare Consulting Senior Nurse Specialist, Research Nokesville, Virginia National Institutes of Health, National Cancer Institute, Center for Cancer Research, Genetics Branch Patricia C. Dykes, PhD, RN, MA Bethesda, Maryland Senior Nurse Scientist, Director Center for Patient Safety Research and Practice Heather Carter-Templeton, PhD, RN-BC Brigham & Women’s Hospital Assistant Professor Boston, Massachusetts The University of Alabama Tuscaloosa, Alabama Veronica D. Feeg, PhD, RN, FAAN Marian Celli, MS, RN C, FHIMSS Gitenstein Professor, Associate Dean Senior Consultant Division of Nursing Beacon Healthcare Consulting Molloy College Potomac, Maryland Rockville Centre, New York FM.indd 11 20-02-2015 19:14:42  xii C ontributors Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. Beth B. Franklin, MS, RN-BC, CPEHR, CPHIT Director, eHealth Programme, International Senior Consultant Council of Nurses Beacon Healthcare Consulting Geneva, Switzerland Nokesville, Virginia Professor (Adjunct) College of Nursing, University of Colorado Barbara B. Frink, PhD, RN, FAAN Denver, Colorado Vice President, Chief Nursing Information Officer Lee Ann Harford, MS, RN MedStar Health Healthcare Informaticist, Project Manager Columbia, Maryland SBG Technology Solutions Associate Faculty Washington, DC Johns Hopkins University School of Nursing Baltimore, Maryland Eileen Healy, DNP, APRN, ANP-BC Instructor, Judy D. Gibson, MSN, RN Saint Louis University Manager School of Nursing JD Gibson Consulting, LLC Independent Consultant Atlanta, Georgia New York, New York Matthew C. Grissinger, RPh, FISMP, FASCP Michelle L. L. Honey, RN, PhD, FCNA (NZ)

 Director, Error Reporting Programs Senior Lecturer Institute for Safe Medication Practices University of Auckland Horsham, Pennsylvania Auckland, New Zealand Elizabeth Casey Halley, BSN, MBA Evelyn J. S. Hovenga, PhD, RN, B App Sc, (RN FHIMSS) MHA, FACS Principal Advisor Professor, CEO, Director, Trainer The MITRE Corporation eHealth Education Pty Ltd, McLean, Virginia Rockhampton, Qld, Australia Kathleen M. Hunter, PhD, RN-BC, CNE

 Kathryn J. Hannah, PhD, RN, FACMI Dean, MSN Indirect Care Tracks Health Informatics Advisor, Canadian Nurses Chamberlain College of Nursing Association Downers Grove, Illinois Professor (Adjunct) School of Nursing Elizabeth (Liz) O. Johnson, MSN, BSN, RN, University of Victoria FCHIME, FHIMSS, CPHIMS, RN-BC Calgary, Alberta, Canada Chief Clinical Informaticist Vice President, Applied Clinical Informatics Nicholas R. Hardiker, BSc (Hons), MSc, PhD Tenet Health Care Professor of Nursing and Health Informatics Dallas, Texas Associate Head, Research & Innovation School of Nursing, Midwifery, Social Work & R. Renee Johnson-Smith, BSN, RN, BS, MBA Social Sciences Risk Manager The University of Salford VA Medical Center Salford, United Kingdom Indianapolis, Indiana FM.indd 12 20-02-2015 19:14:42  Contributors xiii Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. Irene Joos, PhD, RN, MSIS Eija Kivekäs, PhD (c), RN, MSc Professor, Information and Technology Department Project Coordinator Adjunct, Department of Nursing (Former Director of University of Eastern Finland Online Learning) Department of Health and Social Management, La Roche College RECEPS Pittsburgh, Pennsylvania Kuopio, Finland Virpi Jylhä, MSc, PT 

 Sarah Knapfel, BSN, RN, CCRN Researcher iTEAM Project Coordinator Nursing Research Foundation University of Colorado Helsinki, Finland College of Nursing Margaret Ann Kennedy, PhD, MN, BScN, Aurora, Colorado RN, CPHIMS-CA, PMP Atlantic Branch Manager Margaret Ross Kraft, PhD, RN Senior Consultant in Business Analysis Assistant Professor Clinical SME Niehoff School of Nursing Global Village Consulting, Inc. Loyola University Halifax, Nova Scotia, Canada Chicago, Illinois Rosemary Kennedy, PhD, RN, MBA, FAAN Darlene Lacy, PhD, RN-C, CNE CEO Assistant Professor, Director of RN-BSN Program eCare Informatics, LLC Texas Tech University Health Sciences Center, Frazer, Pennsylvania School of Nursing Kingsland, Texas (Telecommuter—Primary campus Karlene M. Kerfoot, PhD, MS, BSN, NEA-BC, FAAN Lubbock, Texas) Chief Clinical Integration Officer API Healthcare, a GE Company Laura Heermann Langford, PhD, RN Hartford, Wisconsin Director, Nursing Informatics Intermountain Healthcare Tae Youn Kim, PhD, RN Director/Assistant Professor Associate Professor Nursing Informatics Program University of California Davis University of Utah Betty Irene Moore School of Nursing Sacramento, California Mary Ann Lavin, DSc, APRN, ANP-BC, FNI, FAAN Kathleen C. Kimmel, BSN, MBA, MHA Emerita, Saint Louis University School of Nursing Senior Instructor Consultant, Founder of Network for Language in University of Colorado School of Nursing Nursing Knowledge Systems (nlinks.org) Denver, Colorado St. Louis, Missouri Ulla-Mari Kinnunen, RN, PhD Chanmi Lee, BSN, RN University Teacher Research Assistant University of Eastern Finland University of Colorado Department of Health and Social Management College of Nursing Kuopio, Finland Aurora, Colorado FM.indd 13 20-02-2015 19:14:43  xiv C ontributors Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. June Levy, MLS Lynn McQueen, DrPH, MS, MPH, RN Vice President Performance Officer Cinahl Information Systems US Department of Health and Human Services Glendale, California Substance Abuse and Mental Health Services Administration LTC Mike Ludwig, MS, RN-BC, CPHIMS Rockville, Maryland Officer in Charge Medical Evaluation and Treatment Unit Bernadette Mazurek Melnyk, PhD, RN, Falls Church, Virginia CPNP/PMHNP, FAANP, FNAP, FAAN Walter Reed National Military Medical Center Associate Vice President for Health Promotion Bethesda, Maryland University Chief Wellness Officer Dean and Professor, College of Nursing Susan H. Lundquist, BSN Professor of Pediatrics & Psychiatry Director of Patient Care Solutions College of Medicine Siemens Healthcare The Ohio State University Malvern, Pennsylvania Columbus, Ohio Michelle M. Mandrack, RN, MSN Director of Consulting Services Susan Meyer, B Soc Sc (Nurs), Dip Paed Nurs Institute for Safe Medication Practices RN, RM, Community Health Nurse, Horsham, Pennsylvania IT Manager Addington Hospital Heimar de Fatima Marin, PhD, RN, MS, FACMI

 Durban, South Africa Full Professor, Vice Dean, Director of the Graduate Program in Health Informatics Irene van Middelkoop, Hons BA (Cur) Nursing School, Universidade Federal de São Paulo RN, RM, Nurse Administrator São Paulo (SP), Brazil Community Health Nurse Durban, South Africa Daniel F. Marsh, MSN, RN-BC Nursing Informatics Specialist Judy Murphy, RN, BSN, FACMI, FHIMSS, FAAN VHA, Office of Informatics & Analytics - Health Chief Nursing Officer Informatics (10P2A) - Applied Informatics Office of the National Coordinator for Health IT Deployment Washington, DC Silver Spring, Maryland Andrea Mazzoccoli, PhD, RN, MSN, MBA, FAAN Lynn M. Nagle, PhD, RN, MScN, BN Chief Nursing Officer and Senior Vice President Assistant Professor Bon Secours Health System University of Toronto Center for Clinical Excellence and Innovation Toronto, Ontario, Canada Baltimore, Maryland Eun-Shim Nahm, PhD, RN, FAAN Mary L. McHugh, BSN, MSN, PhD Professor Provost and Dean of Nursing University of Maryland Angeles College School of Nursing Los Angeles, California Baltimore, Maryland FM.indd 14 20-02-2015 19:14:43  Contributors xv Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. Ramona Nelson, PhD, MN, MSIS, RN-BC, ANEF, Theresa A. Rienzo, MS, RN, BSN, MLIS FAAN Associate Librarian, Health Sciences Professor Emerita, Consulting Molloy College Slippery Rock University Rockville Centre, New York President, Ramona Nelson Consulting Allison Park, Pennsylvania Juliet Rubini, RN-BC, MSN, MSIS Lead Program Analyst Hyeoun-Ae Park, PhD, RN, FAAN Mathematica Policy Research Dean and Professor Oakland, California College of Nursing, Seoul National University Seoul, Korea Sandra Festa Ryan, MSN, RN, CPNP, FCPP, FAANP, FAAN Joel L. Parker, PhD, MS, MA, BSN, PMP Chief Clinical Officer and Robert Wood Johnson Capt., NC, USN, Chief Nurse Informatics Officer Foundation Executive Nurse Fellow Enterprise Information Integration CareCam Health Systems Bureau of Medicine/ Information Delivery Division West Conshohocken, Pennsylvania Defense Health Agency Bureau of Medicine and Surgery/Office of the Navy Kaija Saranto, PhD, RNT, RN, FACMI, FAAN Medicine CIO (M6) Professor, Academic Coordinator Falls Church, Virginia University of Eastern Finland Department of Health and Social Management COL Katherine Taylor Pearson, MA, MS, RN-BC, Kuopio, Finland CPHIMS Assistant Chief of Staff and Joanne M. Seasholtz, MSN, BSN, WMV, Chief Information Officer PhD, FACHE Southern Regional Medical Command Practice Director, Strategic Consulting Siemens, San Antonio, Texas Siemens Healthcare Solutions, Strategic Consulting Malvern, Pennsylvania Diane S. Pravikoff, RN, PhD, FAAN Director of Research Patricia P. Sengstack, DNP, RN-BC, CPHIMS Cinahl Information Systems Chief Nursing Informatics Officer Glendale, California Bon Secours Health System Marriottsville, Maryland Capt. Stephanie J. Raps, BSN, RN-BC Workflow Deputy Division Chief (Air Force Medical Joyce Sensmeier, MS, RN-BC, CPHIMS, Support Agency/SG6W) FHIMSS, FAAN Defense Health Headquarters Vice President, Informatics Falls Church, Virginia HIMSS Chicago, Illinois Janise Richards, PhD, MPH, MS Senior Informatics Advisor Theresa J. Settergren, MHA, MA, RN-BC Centers for Disease Control and Director, Nursing Informatics Prevention (CDC) Cedars-Sinai Health System Atlanta, Georgia Los Angeles, California FM.indd 15 20-02-2015 19:14:43  xvi C ontributors Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. Roy L. Simpson, DNP, RN, DPNAP, FAAN Charlotte A. Weaver, PhD, RN, MSPH, FAAN Vice President, Nursing Senior Vice President, Chief Clinical Officer Cerner Corporation Gentiva® Health Services, Inc. Kansas City, Missouri Atlanta, Georgia Professor, Emory University Nell Hodgson Elizabeth (Betsy) Weiner, PhD Woodruff School of Nursing Senior Associate Dean for Informatics Atlanta, Georgia Centennial Independence Foundation Professor of Nursing and Biomedical Informatics Capt. Lynn A. Slepski, PhD, RN, PHCNS-BC, FAAN Vanderbilt University Senior Public Health Advisor Nashville, Tennessee United States Public Health Service Washington, DC Lucy A. Westbrooke, RN, DipNg, PGDipBus (Health Informatics) Frances (Fran) M. Spivak, MS, RN, CPHIMS Telehealth Programme Manager Director, Health Informatics Auckland District Health Board Walgreens, Health Care Clinics Auckland, New Zealand Deerfield, Illinois Bonnie L. Westra, PhD, RN, FAAN, FACMI Associate Professor and Director Arunkumar Srinivasan, PhD Center for Nursing Informatics Computer Scientist University of Minnesota Centers for Disease Control and Prevention School of Nursing & Institute for Atlanta, Georgia Health Informatics Minneapolis, Minnesota Mark D. Sugrue, BSN, RN-BC, FHIMSS, CPHIMS Chief Nursing Informatics Officer David J. Whitten, MCS Lahey Hospital and Medical Center Medical Informaticist Burlington, Massachusetts Central Regional Hospital Department of Health and Human Services Michelle R. Troseth, MSN, RN, DPNAP, FAAN Butner, North Carolina Chief Professional Practice Officer Luann Whittenburg, PhD, RN, FNP Elsevier Clinical Solutions Chief Nursing Informatics Officer Amsterdam, The Netherlands Medicomp Systems Alexandria, Virginia Denise D. Tyler, MSN/MBA, RN-BC Marisa L. Wilson, DNSc, MHSc, CPHIMS, RN-BC Senior Systems Consultant, Xerox Assistant Professor Adjunct Faculty, Excelsior The Johns Hopkins University House Supervisor, Kaweah Delta Health Care School of Nursing District (Per Diem) Baltimore, Maryland Visalia, California Patricia B. Wise, RN, MS, MA, FHIMSS Judith J. Warren, PhD, RN, FAAN, FACMI COL (USA retired) Professor Emeritus Vice President, Health Information Systems University of Kansas School of Nursing HIMSS Kansas City, Kansas Chicago, Illinois FM.indd 16 20-02-2015 19:14:43  Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. FOREWORD 1 A Turning Point in U.S. Healthcare and forming Accountable Care Organizations, which now The last edition of this book heralded the recent enactment number over 600; patient-centered homes; and population of the Patient Protection and Affordable Care Act (com- health management functions. This necessitates a shift, monly called the Affordable Care Act or ACA), sweeping not only in the physical care setting approach but also in legislation intended to reduce the numbers of uninsured how providers approach care delivery overall: and make healthcare accessible to all Americans. As of 2014, over 7 million enrolled for coverage via the health- As fee-for-service becomes less the norm, provid- ers will move from a care volume to an outcomes care insurance exchange marketplace mandated in the orientation. ACA—surpassing all expectations. Experts predict that these newly insured will increase Demographics and the costs of treating chronic the use of medical services, particularly prescription diseases over time will necessitate a move from drugs and physician and clinical services. By 2022, the the acute-centric environment to multiple venues, numbers of uninsured will drop by 30 million, signaling including outpatient clinics and home-based care. to healthcare providers that a transformation in health- Evidence-based medicine—and the ability to care delivery models must begin now if we are to care for manage volumes of clinical evidence through the newly insured while making significant progress in sophisticated HIT systems—will mean that improving care quality and reducing costs. providers can tailor treatment for the individual Adding to the challenges created by broader insurance and intervene earlier to keep patients well. coverage are simple and complex demographics: by 2040, the 65 and over population will double. This population New care delivery models require a transition from individual care providers to collaborative is also the segment with the highest incidence of chronic teams. diseases. Chronic diseases account for 80% of healthcare costs, not just in the United States but in Europe and We will move from a “sick care” system to one that developing countries—chronic diseases are no longer the focuses on keeping the individual and identified particular scourges of the wealthier western nations. It populations of patients (such as those with is a global wave that threatens to overwhelm healthcare diabetes) healthy. systems unless we find new ways to manage patients and Instead of avoiding care for the chronically ill deliver care over the long term. until it becomes acute, provider organizations In the United States, we have specific issues that may will seek out these populations. Population Health or may not be a product of the current healthcare system Management is intended to deliver specific but that clearly further galvanize the case for change. In the care protocols aimed at managing these United States, it is worth noting that 45% of healthcare costs conditions and improving the health status of are driven by 3% to 5% of the population—the sickest indi- each individual through monitoring and early viduals. But, the next tier of patients, those considered to intervention. This will not only improve health be at the 20% to 30% risk level consumes 35% of healthcare status but also will reduce costs and reduce costs. And consider that one in three Medicare patients is re- re-admissions. admitted within 30 days of an initial hospitalization, largely Patient—and family—engagement will become a due to not receiving or complying with recommended fol- critical component in the care process, particularly low-up care—and that penalties for such re-admissions are in population health management. now in effect. Most sobering is that 33% of care expenses do not contribute to improving the health of an individual. Such shifts require an equally dramatic shift in health- Healthcare organizations have begun the transforma- care information systems, evolving Electronic Health tion of care delivery already, taking on risk-sharing models Record, clinical, and administrative systems from those xvii FM.indd 17 20-02-2015 19:14:43  xviii F oreword 1 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. that support the care “transaction” to those that provide from support of clinical operations to sophisticated tools intelligence-based support to: integral to the delivery of care and management of the health of individuals and populations. Population health Guide clinical diagnostic and therapeutic decisions management and care coordination systems will help bend Ensure that the sequence of care activities conform the cost and outcomes curves, enabling more effective, effi- to the evidence-based practices and performance cient care management of an entire population and helping contract requirements ensure that those individuals dealing with a chronic condi- Monitor the execution of core clinical processes tion do not join the 3%–5% comprising the sickest patients. Nursing professionals are at the center of the new care Capture, report, and integrate into EHRs quality delivery models and care coordination and population and performance measures health management strategies. Always the foundation of Support the interactions of the care team care delivery, the nursing community is the integrator of Identify, assess, stratify, and select target care and in this role will increasingly require advanced populations knowledge and expert use of healthcare information tech- Provide care management interventions for indi- nology. To the authors, editors, and publishers of the Sixth viduals and populations Edition of Essentials of Nursing Informatics—and to all of the Nursing Informatics professionals, our appreciation Provide tools that support and promote patient and for leading the way. family engagement Guide the delivery of high-quality care across John P. Glaser, PhD, FACMI, FCHIME, FHIMSS multiple care settings CEO, Siemens Health Services Monitor, predict, report, and improve on quality Siemens Healthcare performance measures From treating the individual to caring for communi- Gail E. Latimer, MSN, RN, FACHE, FAAN ties or populations of patients to implementing pay-for- Vice President and CNO, Siemens Health Services performance and quality measures, HIT systems will move Siemens Healthcare FM.indd 18 20-02-2015 19:14:43  Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. FOREWORD 2 In the previous edition of Essentials of Nursing being done to improve the speed, accuracy, and utility of Informatics, we predicted that 2010 would be a watershed patient information. With nearly instant access to patient year for accelerating the implementation of electronic data and evidence-based decision support, nurses, physi- health records in the United States. The prediction that cians, and other clinicians will be able make better deci- the “HITECH Act” would forever change health infor- sions about a patient’s care. Health systems are already matics in the United Sates has now been confirmed by progressing toward this goal by embracing new technol- multiple sources, including data from the Office of the ogy that provides real-time notifications and provides National Coordinator for Health Information Technology clinical staff with intervention-level patient data to drive showing that over 84% of eligible hospitals and 69% of improvement in both patient experience and the interac- eligible providers met Stage 1 of “meaningful use” as of tion of caregivers. October 2013. The challenge for the informatics community is to A significant outcome of this widespread adoption ensure the new technologies are seamlessly integrated and and use of health information technology is an increas- that use by caregivers improves the patient experience. It ing focus on nursing informatics. There is a steadily grow- is critical that the electronic health record is transformed ing recognition of the need for nurse informaticists in the into a system that provides output, rather than one pri- transformation of healthcare delivery. Nurse informati- marily receiving input. The appropriate use of informa- cists are healthcare leaders for the twenty-first century, tion structure, information processes, and information exemplars in the right place at the right time, master- technology can support consumers, patients, nurses, and fully employing education, nursing practice, experience, other providers in their decision-making in all roles and and leadership skills to help create effective partnerships. settings. While we have not yet built a nationwide network Their role is a key one in advancing value and science- that supports exchange of both clinical and administra- driven healthcare—moving healthcare information tive health information, that vision is now coming into technology from arduous implementation to ubiquitous sharper focus and is increasingly achievable. When that practice, and healthcare informatics from data manage- network is complete, our ability to put it to good use will ment to decision support. have been enhanced by decades of preparation by nurse The accelerating demands of gathering and using data informaticists. for patient care has increased awareness of informatics Nurse informaticists have been and will continue to be as a core skill and intensified the need for all nurses and leaders in the partnerships between information technol- clinicians to better understand how they can utilize tech- ogy providers, clinicians, and health administrators. The nology. This updated edition incorporates teaching aids to crucial role of nurse informaticists in the development, help educators show and teach others, developing more implementation, and optimization of clinical applications, sophisticated users of technology who can collaborate to including nursing clinical documentation, computerized improve processes and workflow that result in safer, more provider order entry (CPOE), and electronic medical/ effective, and efficient patient care. health records (EMR/EHR), seems to be confirmed by the For decades, primary communication among team results of the HIMSS 2014 Nursing Informatics Workforce members has been accomplished through notes written Survey. The survey indicates the specialty is increasingly in the patient chart. Yet, this represented one of the recognized as adding value, and it continues to thrive. major roadblocks to the most effective and efficient care, Salaries are rising, more nurse informaticists are seeking as the best patient care is dependent on up-to-date data accredited certification, and increasing demand is drawing and timely information sharing among the healthcare some nurses from the bedside. team members, including the patient. Access to the most As the specialty that integrates nursing science, accurate and complete information remains vital, and computer science, and information science to man- as we move from paper charts to mobile devices, nurs- age and communicate data, information, knowledge— ing informaticists are at the center of much of the work and ultimately, wisdom—into nursing practice, nursing xix FM.indd 19 20-02-2015 19:14:43  xx F oreword 2 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. informatics is uniquely positioned to help lead the build- believe even more strongly that our future and the future ing of inter-professional healthcare teams that will effec- of nursing informatics hold even more promise. tively support healthcare transformation. The vision for the future of technology in healthcare will rely heavily on Jonathan B. Perlin, MD, PhD, MSHA, FACP, FACMI these teams to use data to coordinate care and improve President, Clinical Services Group and outcomes, from real-time data mining to recognizing Chief Medical Officer population health patterns to using social media to drive Hospital Corporation of America (HCA) awareness. A decade has passed since the call for ubiquitous Jane D. Englebright, PhD, RN, CENP, FAAN electronic health records was first made in the 2004 Chief Nursing Officer, Patient Safety Officer Presidential State of the Union message. These 10 years and Vice President, Clinical Services Group represent a very long time in the lifespan of health infor- Hospital Corporation of America (HCA) mation technology, and one who has witnessed a rapid evolution of healthcare systems. During this time, nursing informatics has provided tremendous energy, insight Kelly Aldrich, DNP, RN-BC and leadership, not only helping to establish the neces- Informatics Nurse Specialist sary infrastructure but also in driving gains in healthcare Chief Nursing Informatics Officer and technology competency, information literacy, and better Assistant Vice President healthcare outcomes. On the basis of this history, we Hospital Corporation of America (HCA) FM.indd 20 20-02-2015 19:14:43  Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. PREFACE This sixth edition of Essentials of Nursing Informatics was Updates of many other chapters include new refer- initiated in response to requests by educators for a digital ences and new policies, new concepts, and skills required version of the publication, a guide for faculty to use in the by nurses in informatics. All Six continents describing development of their course work, and by nurse users of the International Perspectives updated their unique chapters. fifth edition. Because of these requests we have expanded Because a gap still exists with students, faculty, and the content primarily in the areas: Nursing Informatics nurse users’ understanding the meaning and scope of Technologies—(a) Computer Hardware, (b) Advanced the content, a companion book (Essentials of Nursing Hardware and mHealth, (c) Computer Software, (d) Data Informatics Study Guide/ISBN: 978-0071845892, edited and Data Processing, (e) System Life Cycle, (f ) System Life by Juliana and Jack Brixey, Virginia Saba, and Kathleen Cycle Tools, (g) System and Functional Testing. McCormick) is available that outlines the chapters Seven section editors edited the sixth edition content: and includes sample test questions for every chapter. Nursing Informatics Technologies—Jacqueline Ann Moss; A companion, online faculty resource has also been System Life Cycle, Informatics Theory, Standards, Foundations created to support both books (accessible at www of Nursing Informatics, and Research Applications—.EssentialsofNursingInformatics.com), providing online Virginia K. Saba; Nursing Informatics Leadership—Kathleen PowerPoint slides for chapters, which include objectives, Smith; Advanced Nursing Informatics Practice—Gail E. key words, outlines, and tables/figures. Latimer; Nursing Informatics—Complex Applications, Big With each new edition, we have responded to those Data Initiatives—Kathleen A. McCormick; Educational who teach Nursing Informatics, and who have focused Applications—Diane Skiba; and International Perspectives— the content where they identified areas that they thought Susan K. Newbold. would be most helpful in the profession. Our goal in In addition, this book includes new content that expanding this edition is to increase the number of pro- focuses on innovative expansions in Professional Practice fessional nurses who are prepared in Nursing Informatics using Nursing Informatics such as (a) The Role of the Nurse to work to improve Quality and Outcomes in Healthcare. Executive in Information Technology Decision-Making, There are 6,000 nurses who consider themselves Nurses (b) Care Delivery Across the Continuum: Hospital- in Informatics, and 3,000 credentialed in Nursing Community-Home, (c) Foundations of a Nursing Plan Informatics. We cannot achieve the goals in healthcare and of Care Standard, (d) Health Information Technology, HITECH without more nurses prepared in Informatics. It (e) Striving to Improve Patient Safety, (f ) Federal Health is also our goal to keep all nurses in Informatics up-to-date Care Sector Nursing Informatics, (g) Nurse Scheduling and in the field, and to entice those nurses who are looking for Credentialing Systems, (h) Establishing Nursing Informatics first or second careers in nursing to consider the breadth in Public Policy, (i) Nursing Informatics in Retail Clinics, of areas in Nursing Informatics. Safety, Global Initiatives, and (j) Big Data. We welcomed new authors who have expanded the scope of this book Dr. Virginia K. Saba and added unique expertise in Nursing Informatics. Dr. Kathleen A. McCormick xxi FM.indd 21 17-11-2015 15:12:37 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. This page intentionally left blank  Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. ACKNOWLEDGMENTS This sixth edition book is dedicated to all of the section who contributed to editing the book, completing the pro- editors, chapter authors and their co-authors. Each of duction of this book, and supporting the expansion of the these prestigious contributors was extremely busy imple- book with new resources. The authors also acknowledge menting policies, systems, and educational programs to their families because without them encouraging this support Nursing Informatics in the United States and effort, the book would not be a reality. We thank the Lord abroad. The nurses who are credentialed by the American in giving us the opportunity to embark on a sixth edition Nurses Association, Certification in Nursing Informatics, and for the help in completing it. all 3,000 of them deserve recognition, as well as the 6,000 nurses in informatics in the United States. We acknowl- edge our international colleagues in nursing informatics. Dr. Virginia K. Saba We also acknowledge the McGraw-Hill Education staff Dr. Kathleen A. McCormick xxiii FM.indd 23 20-02-2015 19:14:43 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. This page intentionally left blank  Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. The authors would like to sincerely thank the following for content in the fifth edition that has been updated in the sixth edition. 1 Historical Perspectives of Nursing 44 Initiation and Management of Accessible, Informatics Effective Online Leaning Patricia Wise Enola Boyd, deceased. 3 Advanced Hardware and mHealth 45 Social Media in the Connected Age: Impact Thomasine D. Guberski on Healthcare Education and Practice Kay Lynn Olmsted, Paul D. Guillory 5 Open Source and Free Software Peter Murray and E. Scott Erdley 46 A Paradigm Shift in Simulation: Experimental Learning in Virtual Worlds 8 Standardized Nursing Terminologies Patricia A. Tringenstein Suzanne Bakken, Connie White Delaney, Bonnie Westra 48 Information Literacy and computerized Information Resources 11 System Life Cycle Annelle Tanner M. Kathleen Smith and Denise D. Tyler 51 Nursing Informatics in Canada 18 Establishing Nursing Informatics Nora Hammell in Public Policy Amy M. Walker 52 Nursing Informatics in Europe 20 Assessing the Vendors Kaarina Tanttu Ann Patricia Farrell and Sheryl L. Taylor 53 Pacific Rim Perspective 21 Nurse Scheduling and Credentialing Robyn Carr Systems 54 Nursing Informatics in Asia Richard Robinson, Kathy Malloch, Lisa LaBau Korea - InSook Cho, Japan - Satoko Tsuru, 23 Structuring Advanced Practice Knowledge: Taiwan & Hong Kong- Polun Chang, Rung- Curricular, Practice and Internet Chuang Feng, Ming-Chuan Kuo, Li-Ping Fang, Resource Use Xiang-Fen Lai, Ming-Ziang Tu Laketa Entzminger APPENDIX A Overview of Clinical Care 35 Consumer/Patient Engagement and eHealth Classification System Resources Jacqueline Ann Moss Rita D. Zielstorff FM.indd 25 20-02-2015 19:14:43 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. This page intentionally left blank Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. 20-02-2015 17:23:49 1 Nursing Informatics Technologies Jacqueline Ann Moss part c01.indd 1 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. This page intentionally left blank  1 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. Historical Perspectives of Nursing Informatics Virginia K. Saba / Bonnie L. Westra OBJECTIVES 1. Describe the historical perspective of nursing informatics. 2. Explore lessons learned from the pioneers in nursing informatics. 3. Describe the types of nursing standards initiatives. 4. Review the historical perspectives of electronic health records. 5. List the major landmark events and milestones of nursing informatics. KEY WORDS Computers Computer literacy Computer systems Data standards Electronic Health Records (EHR) Healthcare Information Technology (HIT) Information systems Internet Nursing informatics healthcare is indisputable. HIT is an all-encompassing OVERVIEW term referring to technology that captures, processes, Nursing Informatics (NI) is a title that evolved from the and generates healthcare information. Computerization French word “informatics” which referred to the field of and/or electronic processing affect all aspects of health- applied computer science concerned with the process- care delivery including (a) provision and documentation ing of information such as nursing information (Nelson, of patient care, (b) education of healthcare providers, 2013). The computer was seen as a tool that could be used (c) scientific research for advancing healthcare deliv- in many environments. In the early 1960s, the computer ery, (d) administration of healthcare delivery services, was introduced into healthcare facilities for the process- (e) reimbursement for patient care, (f ) legal and ethical ing of basic administrative tasks. Thus the computer revo- implications, as well as (d) safety and quality issues. lution in healthcare began and led to today’s healthcare Since its inception there has been a shift from the use information technology (HIT) and/or electronic health of mainframe, mini- or microcomputers (PCs) toward record (EHR) systems. integrating multiple technologies and telecommunica- The importance of the computer as an essential tool tion devices such as wireless, handheld, mobile comput- in HIT systems and in the delivery of contemporary ers, and cell phones designed to support the continuity of 3 c01.indd 3 20-02-2015 17:23:49  4 P art 1 N ursing I nformatics T echnologies Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. care across healthcare settings and HIT systems. There complexity from physicians’ handmaidens to professional has also been a dramatic shift from visible to invisible status. These events provided the impetus for the profes- storage devices such as cloud storage, and from develop- sion to embrace computers—a new technological tool. ing instructions for old software programs to today’s icon, Computers were initially used in healthcare facilities user-friendly, menu-driven, touch-screen manipulation for basic office administrative and financial accounting methods for activating software programs. functions. These early computers used punch cards to Today, computers in nursing are used to manage store data and card readers to read computer programs, patient care information, monitor quality, and evaluate sort, and prepare data for processing. They were linked outcomes. Computers and networks are also being used together and operated by paper tape using teletypewriters for communicating (sending and receiving) data and mes- to print their output. As computer technology advanced, sages via the Internet, accessing resources, and interacting the healthcare technologies also advanced. The major with patients on the Web. Nurses are increasingly becom- advances are listed chronologically in Table 1.2. ing involved with systems used for planning, budgeting, and policy-making for patient care services, as well as 1960s. During the 1960s, the uses of computer technol- enhancing nursing education and distance learning with ogy in healthcare settings began to be explored. Questions new media modalities. Computers are also used to docu- such as “Why use computers?” and “What should be com- ment and process real-time plans of care, support nursing puterized?” were discussed. Nursing practice standards research, test new systems, design new knowledge data- were reviewed, and nursing resources were analyzed. bases, develop data warehouses, and advance the role of Studies were conducted to determine how computer nursing in the healthcare industry and nursing science. technology could be utilized effectively in the healthcare This chapter is an updated and revised version of the industry and what areas of nursing should be automated. Chapter 2 “Historical Perspectives of Nursing Informatics” The nurses’ station in the hospital was viewed as the hub (Saba & Westra, 2011) published in the fifth edition of of information exchange, the most appropriate center for Essentials of Nursing Informatics (Saba & McCormick, the development of computer applications. 2011). In this chapter, the significant events influencing the By the mid-1960s, clinical practice presented nurses growth of NI as a nursing specialty are analyzed according with new opportunities for computer use. Increasingly to (1) Seven Time Periods, (2) a synthesis of lessons learned complex patient care requirements and the proliferation from 33 videotaped interviews with Nursing Informatics of intensive care units required that nurses become super Pioneers, (3) Nursing Standards Initiatives including users of computer technology as nurses monitored patients’ nursing practice and education, nursing content standards, status via cardiac monitors and instituted treatment regi- and confidentiality and security standards, (4) Electronic mens through ventilators and other computerized devices. Health Records from a Historical Perspective, and A significant increase in time spent by nurses document- (5) Landmark Events in Nursing and Computers with ing patient care, in some cases estimated at 40% (Sherman, Table 1.2 listing those events that influenced the introduc- 1965; Wolkodoff, 1963), as well as a noted rise in medica- tion of computers into the nursing profession including key tion administration errors prompted the need to investigate “computer/informatics” nurse(s) that directed the activity. emerging hospital computer-based information systems. 1970s. During the late 1960s through the 1970s, hospitals MAJOR HISTORICAL PERSPECTIVES began developing computer-based information systems OF NURSING AND COMPUTERS which initially focused on physician order entry and results reporting, pharmacy, laboratory, and radiology reports, Seven Time Periods information for financial and managerial purposes, and Prior to 1960s. Computers were first developed in the physiologic monitoring systems in the intensive care late 1930s to early 1940s, but their use in the healthcare units, and a few systems started to include care planning, industry occurred in the 1950s and 1960s. During this decision support, and interdisciplinary problem lists. time, there were only a few experts nationally and inter- While the content contained in early hospital informa- nationally who formed a cadre of pioneers that attempted tion systems frequently was not specific to nursing prac- to adapt computers to healthcare and nursing. At that time tice, a few systems did provide a few pioneer nurses with the nursing profession was also undergoing major changes. a foundation on which to base future nursing information The image of nursing was evolving, the number of educa- systems (Blackmon et al., 1982; Collen, 1995; Ozbolt & tional programs and nurses increasing, and nursing prac- Bakken, 2003; Romano, McCormick, & McNeely, 1982; tices and services were expanding in scope, autonomy, and Van Bemmel & Munsen, 1997). Regardless of the focus, c01.indd 4 20-02-2015 17:23:50  Chapter 1 Historical Perspectives of Nursing Informatics 5 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission. which remained primarily on medical practice,