INTELLECTUAL-PROPERTY-RIGHT.docx

**INTELLECTUAL PROPERTY RIGHT** ##### ** THE IPR CONTEXT** - According to the World Intellectual Property Organization (WIPO), intellectual property (IP) is divided into two categories, namely, industrial property and [copyright.] Industrial property includes inventions (patents), tr...

**INTELLECTUAL PROPERTY RIGHT** ##### ** THE IPR CONTEXT** - According to the World Intellectual Property Organization (WIPO), intellectual property (IP) is divided into two categories, namely, industrial property and [copyright.] Industrial property includes inventions (patents), trademarks, industrial designs, and geographic indications of source; while copyright includes literary and artistic works such as novels, poems and plays, films, musical works, artistic works such as drawings, paintings, photographs and sculptures, and architectural designs[.] - However, exclusive rights of the scientists, researchers, inventors, artists, and other gifted citizens in our country are not suitably protected as they should be[.] Most of them have apprehensions in applying for intellectual property rights[.] ##### ##### ##### ##### **INTELLECTUAL PROPERTY RIGHT (IPR)** The term \"intellectual property rights\" consists of: - Copyright and Related Rights - Trademarks and Service Marks - Geographic Indications - Industrial Designs - Patents - Layout-Designs (Topographies) of Integrated Circuits - Protection of Undisclosed Information ##### **GOVERNMENT AGENCIES **The agency of the government in charge of the implementation of the Intellectual Property Code is the Intellectual Property Office which replaced the Bureau of Patents, Trademarks and Technology Transfer. It is divided into six \[6\] Bureaus, namely: - Bureau of Patents - Bureau of Trademarks - Bureau of Legal Affairs - Documentation, Information and Technology Transfer Bureau  - Management Information System and EDP Bureau - Administrative, Financial and Personnel Services Bureau[.] ##### **INTELLECTUAL PROPERTY OFFICE** The Intellectual Property Office of the Philippines (IPOPHL) is the lead agency responsible for handling the registration and conflict resolution of intellectual property rights**.** It was created by virtue of Republic Act No**.** 8293 or the Intellectual Property Code of the Philippines, which took effect on January 1, 1998 under the presidency of Fidel V. Ramos. ##### ##### **PATENTS** - A Patent is a grant issued by the government through the - Intellectual Property Office of the Philippines. It is an exclusive right granted for a product, process or an improvement of a product or process which is new, inventive and useful. This exclusive right gives the inventor the right to exclude others from making, using, or selling the product of his invention during the life of the patent. - A patent has a term of protection of twenty (20) years providing an inventor significant commercial gain. In return, the patent owner must share the full description of the invention. ##### ** ***PATENTABLE INVENTIONS* Any technical solution of a problem in any field of human activity which is new, involves an inventive step and is industrially applicable shall be patentable. ##### *NON-PATENTABLE INVENTIONS* - - - - - - - - - - - - *REQUIREMENT FOR PATENTABILITY* - NOVELTY - INVENTIVE STEP - INDUSTRIAL APPLICABILITY *REQUIREMENTS FOR FILING A PATENT* - Request for the Grant of Patent - Description of the Invention (Specification and Claim/s) - Drawings necessary for the Invention (if any) - Filing Fee **TRADEMARKS** *\"Mark\"* means any visible sign capable of distinguishing the goods (trademark) or services (service mark) of an enterprise and shall include a stamped or marked container of goods**[.]** A *trademark* is a tool used that differentiates goods and services from each other**[.]** It is a very important marketing tool that makes the public identify goods and services**[.]** A trademark can be one word, a group of words, sign, symbol, logo, or a combination of any of these**[.]** Generally, a trademark refers to both trademark and service mark, although a service mark is used to identify those marks used for services only**[.]** *TRADEMARK PROTECTION* A trademark can be protected through registration**[.]** Registration gives the trademark owner the exclusive right to use the mark and to prevent others from using the same or similar marks on identical or related goods and services**[.]** Before applying for trademark registration, it would help if you conduct a search in the trademarks database to determine if there are identical or similar marks that would prevent the registration of your mark**[.]** This is to prevent future conflicts with marks that are already registered or with earlier filing dates**[.]** *TRADEMARK REGISTRATION* - The name and address of the applicant - The name of a State of which the applicant is a national or where he has domicile - Where the applicant is a juridical entity, the law under which it is organized and existing - The appointment of an agent or representative, if an applicant is not domiciled in the Philippines - Where the applicant claims the priority of an earlier application, an indication of: The name of the State with whose national office the earlier application was filed or it filed with an office other than a national office, the name of that office \ The date on which the earlier application was filed \ Where available, the application number of the earlier application - Where the applicant claims color as a distinctive feature of the mark, a statement to that effect as well as the name or names of the color or colors claimed and an indication, in respect of each color, of the principal parts of the mark which are in that color; - Where the mark is a three-dimensional mark, a statement to that effect - One or more reproductions of the mark, as prescribed in the Regulations - A transliteration or translation of the mark or of some parts of the mark, as prescribed in the Regulations - The names of the goods or services for which the registration is sought, grouped according to the classes of the Nice Classification, together with the number of the class of the said Classification to which each group of goods or services belongs - A signature by, or other self-identification of, the applicant or his representative[.] **COPYRIGHT** ------------- ##### ** COPYRIGHT** *\ Copyright* is the legal protection extended to the owner of the rights in an original work**[.]** *"Original work"* refers to every production in the literary, scientific and artistic domain**.** Among the literary and artistic works enumerated in the IP Code includes books and other writings, musical works, films, paintings and other works, and computer programs. Works are protected by the sole fact of their creation, irrespective of their mode or form of expression, as well as their content, quality and purpose. Thus, it does not matter if, in the eyes of some critics, a certain work has little artistic value. So long as it has been independently created and has a minimum of creativity, the same enjoys copyright protection. *WORKS COVERED BY COPYRIGHT PROTECTION* - Books, pamphlets, articles and other writings - Periodicals and newspapers - Lectures, sermons, addresses, dissertations prepared for oral delivery, whether or not reduced in writing or other material form - Letters - Dramatic or dramatico-musical compositions; choreographic works or entertainment in dumb shows - Musical compositions, with or without words - Works   of drawing, painting, architecture, sculpture, engraving, lithography or other work of art; models or designs for works of art - Original ornamental designs or models for articles of manufacture, whether or not registrable as an industrial design, and other works of applied art - Illustrations, maps, plans, sketches, charts and three-dimensional works relative to geography, topography, architecture or science - Drawings or plastic works of a scientific or technical character q Photographic works including works produced by a process analogous to photography; lantern slides - Audiovisual works and cinematographic works and works produced by a process analogous to cinematography or any process for making audio-visual recordings - Pictorial illustrations and advertisements - Computer programs - Other literary, scholarly, scientific and artistic works[.] ##### *TERM OF PROTECTION OF COPYRIGHT* - In general, the term of protection of copyright for original and derivative works is the life of the author plus fifty (50) years after his death[.] The Code specifies the terms of protection for the different types of works[.] - In calculating the term of protection, the term of protection subsequent to the death of the author shall run from the date of his death or of publication, but such terms shall always be deemed to begin on the first day of January of the year following the event which gave rise to them (i[.]e[.] death, publication, making)[.] ##### *COPYRIGHT INFRINGEMENT* Copyright infringement consists in infringing any right secured or protected under the Code. It may also consist in aiding or abetting such infringement. The law also provides for the liability of a person who at the time when copyright subsists in a work has in his possession an article which he knows, or ought to know, to be an infringing copy of the work for the purpose of: - Selling or letting for hire, or by way of trade offering or exposing for sale or hire, the article - Distributing the article for the purpose of trade, or for any other purpose to an extent that will prejudice the rights of the copyright owner in the work - Trade exhibit of the article in public[.] ##### *COPYRIGHT REGISTRATION* - A duly accomplished form in duplicate for each work, provided, that a separate application is submitted for each number of a periodical containing a notice of copyright. - A support document evidencing ownership of the copyright, the manner of its acquisition if the claimant is not the original author translator, or editor, and where and in what establishment the work was made, performed, printed, or produced, and the date of its completion and publication. - Receipt showing payment of the registration fee if the application is filed personally, or by postal money order if the application is filed by registered mail[.] - Documentary stamps in the correct amount, which shall be affixed to the registration and deposit certificate. - Two (2) complete copies or reproduction of the work or replica or picture - Two (2) printed copies with the copyright notice printed in front or at the back of the title page or on any conspicuous space for a non-book material, if the work is a published work. ##### *INDUSTRIAL DESIGN* An industrial design is the ornamental or aesthetic aspect of an article. The design may consist of three-dimensional features, such as the shape or surface of an article, or of two-dimensional features, such as patterns, lines or color. Industrial designs are applied to a wide variety of products of industry and handicraft: from technical and medical instruments to watches, jewelry, and other luxury items; from house wares and electrical appliances to vehicles ; from textile designs to leisure goods. To be protected under most national laws, an industrial design must be non-functional. This means that an industrial design is primarily of an aesthetic nature and any technical features of the article to which it is applied are not protected. ##### ##### ##### ##### *DESIGN PROTECTION* When an industrial design is protected, the owner -- the person or entity that has registered the design -- is assured an exclusive right against unauthorized copying or imitation of the design by third parties. This helps to ensure a fair return on investment. An effective system of protection also benefits consumers and the public at large, by promoting fair competition and honest trade practices, encouraging creativity, and promoting more aesthetically attractive products. ##### UTILITY MODELS A Utility Model is a protection option, which is designed to protect innovations that are not sufficiently inventive to meet the inventive threshold required for standard patents application. It may be any useful machine, implement, tools, product, composition, process, improvement or part of the same, That is of practical utility, novelty and industrial applicability. A utility model is entitled to seven (7) years of protection from the date of filing, with no possibility of renewal.\ \ \ *UTILITY MODELS---REGISTRATION* An application for registration should contain a duly accomplished request for registration as prescribed by the Bureau, specification or description containing the following: - Title - Technical field - Background of the Utility Model - Brief description of the several views of the drawings - Detailed description - Claim or claims - Drawings - Abstract of the disclosure[.] **PHILIPPINE COPYRIGHT LAW** ---------------------------- **\ Intellectual Property Code of the Philippines**, or **Republic Act No. 8293**, specifically the **Law on [Copyright]**.\ \ Is enshrined in the Intellectual Property Code of the Philippines, officially known as Republic Act No. 8293.\ Law is partly based on United States copyright law\ Principles of the Berne Convention for the Protection of Literary and Artistic Works.\ Also protect patents, trademarks, and other forms of intellectual property.\ There are laws that protect copyrights: the Optical Media Act (which protects music, movies, computer programs, and video games) is an example of such.\ Enforced through a body established by the law: the Intellectual Property Office, or IPO, and its various branches.\ Implementation is done with the coordination of the IPO and the Copyright Division of the National Library of the Philippines. The Intellectual Property Code gives the power of mediating copyright problems (before, during, and after the copyright application process) to a bureau of the Intellectual Property Office known as the Bureau of Legal Affairs, as covered by Section 10 of the code. This body is empowered with the following functions:\ 1. Hear objections on items being applied for copyright 2\. Address copyright violations where damages are no less than 200,000 pesos\     a. Give the following penalties for copyright violations:\      i. Issue cease and desist orders which have a fixed time where the copyright violator must stop violating the copyright being infringed\      ii. Accept voluntary orders of compliance or discontinuance as ordered by the Director of Legal Affairs which must consist of the following:\      iii. Assurance to comply with the intellectual property law violated\      iv. Assurance to refrain from unlawful activity on the case being investigated v. Assurance to refund, replace, recall, or repair defective products vi. Assurance to reimburse the complainant (usually the copyright holder) of all charges, fees, and payments related to the case\      vii. Seizure of the products that have been subject to infringement\      viii. Forfeiture of all paraphernalia and properties (whether real or personal) involved with the infringement\      ix. Imposition of administrative of fines no less than 50,000 pesos but no more than 300,000 pesos. For every day of continued violation, a fine of 5,000 pesos is imposed.     \      x. Cancellation of any document (permit, registration, etc.) attributed to the product at the discretion of the Director of Legal Affairs\      xi. Withholding of any document pending approval of the Bureau from the respondent (the copyright violator)\      xii. Assessment of damages\      xiii. Censorship of the product\      xiv. Other penalties in line with Executive Order 983 (1983) ** THE PHILIPPINE DATA PRIVACY ACT OF 2012** -------------------------------------------- DATA PRIVACY IS ABOUT 1. People, not Places 2. Personal Choice 3. Control, not Secrecy 4. The right to be left alone THE 4th INDUSTRIAL REVOLUTION - Data as the new oil of the digital economy  DATA PROTECTION - Confidentiality - Availability - Integrity - Compliance DATA PRIVACY     - Accountability - Assurance - Operational Compliance - Demonstrable Compliance *PROBLEMS ENCOUNTERED BY INDIVIDUALS during PROCESSING PERSONAL INFORMATION* - Loss of trust - Loss of self- determination - Loss of liberty - Exclusion - Physical harm - Discrimination - Stigmatization - Power imbalance What does the LAW say? The law upholds the right to privacy by [protecting individual personal information**.**] The National Privacy Commission protects individual personal information by [regulating the processing of personal information**.**] ú *THE SCOPE OF DPA 2021* Section 4: Applies to the processing of all types of personal information, in the country and even abroad, subject to certain qualifications**[.]** *PERSONAL INFORMATION*      - Any information whether recorded in a material form or not, from which the identity of an individual is apparent or can be reasonably and directly ascertained by the entity holding the information, or when put together with other information would directly and certainly identify an individual[.] - Section 12 of the Act provides conditions under which processing Personal Information is ALLOWED[.] *SEC[.] 12:  The processing of personal information shall be permitted only if not otherwise prohibited by law, and when at least one of the following conditions exists:* *(a) The data subject has given his or her consent;* \(b) The processing of personal information is necessary and is related to the fulfillment of a contract with the data subject or in order to take steps at the request of the data subject prior to entering into a contract; \(c) The processing is necessary for compliance with a legal obligation to which the personal information controller is subject; \(d) The processing is necessary to protect vitally important interests of the data subject, including life and health; \(e) The processing is necessary in order to respond to national emergency, to comply with the requirements of public order and safety, or to fulfill functions of public authority which necessarily includes the processing of personal data for the fulfillment of its mandate; or \(f) The processing is necessary for the purposes of the legitimate interests pursued by the personal information controller or by a third party or parties to whom the data is disclosed, except where such interests are overridden by fundamental rights and freedoms of the data subject which require protection under the Philippine Constitution**[.\ \ ]** **SENSITIVE PERSONAL INFORMATION** ==================================   (1)       race, ethnic origin, marital status, age, color, and religious, philosophical or political affiliations; (2)       health, education, genetic or sexual life of a person, (3)       civil, criminal or administrative proceedings (4)      Unique identifiers issued by government agencies peculiar to an individual (5)      Specifically established by law as classified *Note: Section 13= Processing of Sensitive Personal Information is prohibited except in the following cases...\ * *PROCESSING       *  Any operation of any set of operations performed upon personal data including, but not limited to, the collection, recording, organization, storage, updating or modification, retrieval, consultation, use, consolidation, blocking, erasure or destruction of data**[.]**  \* * *PERSONAL INFORMATION CONTROLLER* - A natural or juridical person, or any other body who controls the processing of personal data, or instructs another to process personal data on its behalf[.] - It excludes: \- A natural person who processes personal data in connection with his or her personal, family, or household affairs\ \ y ###### **OBLIGATIONS of PICs** 1. The PIC should collect personal information for specified and legitimate purposes determined and declared before, or as soon as reasonably practicable after collection 2. The PIC should collect and process personal information adequately and not excessively 3. The PIC should process personal information fairly and lawfully, and in accordance with the rights of a data subject 4. The PIC should process accurate, relevant and up to date personal information[.] 5. The PIC should retain personal information only for as long as necessary for the fulfillment of the purposes for which the data was obtained[.] The information should be kept in a form which permits identification of data subjects for no longer than is necessary *PERSONAL INFORMATION *PROCESSOR - Any natural or juridical person or any other body to whom a personal information controller may outsource or instruct the processing of personal data pertaining to a data subject[.] *DATA SUBJECT   *   An individual whose personal, sensitive personal or privileged information is processed**[.]** Right to be Informed\ Right to Access\ Right to Object\ Right to Rectification\ Right to Erasure or Blocking\ Right to Damages\ Right to Data Portability\ Right to File A Complaint ### DATA PRIVACY PRINCIPLES   A data subject must be aware of the nature, purpose, and extent of the processing of his or her personal data, including the risks and safeguards involved, the identity of personal information controller, his or her rights as a data subject, and how these can be exercised**[.]** Any information and communication relating to the processing of personal data should be easy to access and understand, using clear and plain language**[.]**   The processing of information shall be compatible with a declared and specified purpose, which must not be contrary to law, morals, or public policy**[.]**    CONSENT OF THE DATA SUBJECT Refers to any freely given, specific, informed indication of will, whereby the data subject agrees to the collection and processing of personal information about and/or relating to him or her**[.]** Consent shall be evidenced by written, electronic or recorded means**[.]** It may also be given on behalf of the data subject by an agent specifically authorized by the data subject to do so**[.]**     Evidenced by written, electronic or recorded means: ü  signature\ ü  opt-in box/clicking an icon\ ü  sending a confirmation email\ ü  oral confirmation   \    \ \ Unbundled Consent \ \ Granular Consent\ \ \ \ \ \ The processing of information shall be adequate, relevant, suitable, necessary, and not excessive in relation to a declared and specified purpose**[.]** Personal data shall be processed only if the purpose of the processing could not reasonably be fulfilled by other means**[.]** THE FIVE PILLARS OF COMPLIANCE **\ [Privacy vs Confidentiality\ ]**\ Privacy is the state when an individual is free from public interruption and intrusion. The word *privacy* is derived from the word *\'private*\' which means the role of the public is limited, so the term privacy refers to a condition where a person is apart from public attention and observation. It is the *right of every individual to be left alone in his personal matters because everybody has his personal life. He can draw a boundary on the access of his information from the use of others (Surbhi, S., 2018).*\ \ Moreover, Surbhi states that it is a human tendency to hide certain facts about himself or else people will use them against him.\ \ In addition, Surbhi believes that privacy is a matter of choice of an individual if he doesn\'t want to disclose his / her matter in front of people. For example, It is quite logical that ifa person wants to take a bath or change his clothes or he wants to have a personal conversation with someone he will seek some privacy because he does not want anybody\'s interference in his private moments. A good example of Internet privacy is here; you can set privacy on your social networking site account to limit the access of your personal stuff like who can see your stuff, profile picture, photos etc. (Surbhi, S., 2018).\ \ On the other hand, Surbhi defines confidentiality as a state when it is intended or expected from someone to keep the information secret. The term confidentiality extracted from the word \'confidence\' which means \"trust.\" In this way, confidentiality is when it is entrusted that the information which is told in confidence to someone, will be kept secret from the reach of unauthorized people until the parties agree to uncover the information.\ \ In Medical, Legal, and other professions, it is common that the information shared between client and solicitor or doctor and patient, will not be told to the third party. In the military, this term is scores of times that only authorized officers are allowed to access the confidential information. It prevents the access of sensitive information from being public.\ \ Surbhi provides an example to understand confidentiality easily like one\'s bank details like account number or ATM pin or user id and password of any social networking site or an email account.\ \ **Specifically, the following are the major differences between privacy and confidentiality (Surbhi 2018):\ **\ *\*Privacy is a situation when a person is free from public interference. Confidentiality is a situation when information is kept secret from the reach of any other person.\ \ \*Privacy talks about a person, but Confidentiality is about information.\ \ \*Privacy restricts the public from accessing the personal details about a person, whereas Confidentiality protects the information from the range of unauthorized persons.\ \ \*In privacy, everyone is disallowed from interfering in the personal matters of a person. Conversely, in confidentiality some specified and trustworthy people are allowed to have access to the information.\ \ \*Privacy is at the voluntary; it is the choice of a person. In contrast to Confidentiality, it is compulsory if the relationship between parties is a fiduciary.\ \ \*Privacy is a right. However, Confidentiality is an agreement.\ *\ *In conclusion, Privacy and Confidentiality are the two terms which are commonly juxtaposed with each other. Privacy is about personal or private i.e. the range will be limited to yourself only while if we talk about confidentiality, it is professional. The range will be limited the persons, to whom the individual has trust There are only a few differences between the two terms, but Confidentiality is an advanced version of Privacy (Surbhi, S., 2018).* **The Importance of Preserving Anonymity, Confidentiality and Privacy of Health Information are as follows:\ **\ 1. To ensure safe and compassionate nursing practice that includes an understanding of the ethico-moral and legal boundaries within which nurses must function vis- a- vis protecting the patient\'s rights to: respect of human dignity; anonymity, privacy, and confidentiality of health information.\ \ Nurses must understand the ethico-moral and legal implications of nursing to be able to determine what is good or valuable for all people and to judge what is right and wrong.\ \  Furthermore, the nurse must understand the law to protect themselves from liability and to protect their client\'s rights.\ \ As technology has expanded the role of the nurse, the ethical dilemmas associated with the client care and health information have increased and often become legal issues as well. Nurses\' familiarity with ethico-moral and legal implications of nursing, enhances their ability to be client advocate.\ \ 2. To ensure protection of patients from identity theft, and other improper use of patient information, specifically for financial gain.\ \ 3. To maintain patient\'s trust. Thus, they will prevent hiding certain facts about themselves.\ During this present times of crisis caused by the pandemic COVID 19, the very devastating\ effect of patients not being forthright with their history of travels, being exposed to PUIs, PUMs, having signs and symptoms of \"ULAN\" (U-bong walang plema; LA-gnats N-ahihirapan sa paghinga) had caused the untimely, heart- breaking deaths of doctors, nurses, other healthcare workers and frontliners.\ \ REMEMBER: Open and honest communication between the patient and the health care workers is of utmost importance for therapeutic relationship.\ \ 4. The integrity and availability of the electronic health information will be essential to physicians and the entire clinical team to be able to trust the data for patient care and decision making.\ \ 5. To prevent unintended consequences detrimental to health research and public health practice.\ \ 6. To ensure availability of accurate health information when needed by the patient.\ \ 7. To help maintain a professional attitude in health care settings. 8\. To prevent legal suits\-\--thus avoid negative repercussions on the health care institution\'s\' reputation.**\ \ ** **\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ CHAPTER 6:\ APPLICATIONS OF INFORMATICS IN EVIDENCE-BASED NURSING PRACTICE\ \ *After studying this chapter, the student is expected to:*** 1. Provide evidence-based nursing care using nursing informatics and technology system. 2. Apply guidelines and principles of evidence-based nursing practice utilizing information technology. 3. Compare and contrast practice protocol, clinical guidelines and critical pathways 4. Discuss computer generated nursing care plans and critical pathways 5. Research on different e-journals on nursing 6. Manipulate beta versions of identified EMRs **KEY TERMS:** Computer Generated Nursing Care Plans Critical Pathways\ E-journals **LESSON 1: Computer-generated Nursing Care Plans and Critical Pathways** **\ Computer Generated Nursing Care Plans** Nursing care plans or NCPs as we use them in our conversations with our colleagues, have been introduced to us during our stay in the nursing school. It has been used extensively inside the academic institution as an essential teaching tool to present the value of planning patient care, which has been also reinforced by the Joint Commission on Accreditation for hospitals (JCAH). But in actual clinical settings, it is difficult to find completely written nursing care plans. If in any case that a written care plan is found, they can be incomplete, outdated, rarely used for determining care and infrequently relied upon as a means of communicating problem management from one shift to another. The nurses view the care plan burdensome, as it Is time-consuming paperwork, preparation or revision of the plan is low in practice settings (Dharmarajan and Gangadharan, 2013). It is with this practice that the initiation of a computer-generated nursing care plan was done.\ \ The computer-generated nursing care plans promotes the value of planning care but at the same time addresses the burden of the workload NCPs can consume from the nurses. It works by providing a template that nurses can work on and modify based on the individual cases of their clients. **CRITICAL PATHWAYS[\ ]**\ **Critical Pathways**\ \ Care pathways are considered to be one of the best tools hospitals can use to manage the quality in healthcare concerning the standardization of care processes, since they promote organized and efficient patient care based on evidence. It has been proven that their implementation reduces the variability in clinical practice and improves outcomes.\ \ Care pathways are also known as Clinical or Critical pathways. A care pathway is a multidisciplinary healthcare management tool based on healthcare plans for a specific group of patients with a predictable clinical course, in which the different tasks or interventions by the professionals involved in the patient care (physicians, nurses. pharmacists, physical therapists, social workers etc.) are defined, optimized and sequenced either by hour (ED) or day (acute care). Outcomes are tied to specific interventions.\ \ The care pathway concept appeared for the first time in 1985 inspired by Karen Zander and Kathleen Bower at the New England Medical Center in Boston (Massachusetts, USA). Care pathways are usually represented as a Gantt chart (Figure 1). \ \ So far, different systematization tools were being used for clinical processes. The oldest and most known are medical and nursing protocols. Over the last years other tools were introduced, such as clinical practice guidelines and standardized nursing care maps. Care pathways are care protocols that embrace all of these tools (Figure 2). The main goal of care pathways is based on the improvement of the following areas: quality in healthcare, coordination / cooperation among professionals, efficiency and patient satisfaction. Thus, the purpose of pathways is the enhancement of care processes in three areas: quality, safety and efficiency.\ \ Care pathways are a powerful tool for care process management, since they permit to check the compliance of all the interventions included in the healthcare plan, fix care standards and introduce clinical audits as a part of the process. Likewise, pathways are very useful to identify improvement areas in these standardized care processes, under the umbrella of Continuous Quality Improvement (CQI).\ \ The development and implementation of a care pathway involves a change in the organizational culture at any setting. This process may involve overcoming of some hurdles in its way of implementation. Following are some of the activities to be done to develop and implement a care pathway:\ \ Preparing multidisciplinary documents\ \ Reviewing the process by all the concerned staff\ \ Holding care pathway meetings to facilitate the exchange of opinions about patient care by different professionals\ \ Conducting periodic reviews to monitor some defined indicators\ \ Analyzing variances or deviations\ \ Preparing common record documents for all the staff\ \ Some barriers in developing and implementing a pathway are identified: the heterogeneity of patients and diagnosis, the common reluctance among organizations and professionals to change. Hospital managers must consider these barriers since they may threaten a successful implementation of care pathways.\ \ **How to document variances? (Institutional guidelines may apply and not strictly confined to the guidelines below)**\ \ 1. Similar to DAR (Data, Action, and Response) format, we utilize VAO (Variance, Action, and Outcome) to document variances.\ \ 2. Variance - includes all subjective and objective data observed by the nurse to be outside of the pathway management of the patient\'s case.\ \ 3. Action - includes all interventions used to address the variance\ \ 4. Outcome - includes all patient care outcomes after the interventions were performed to address the variance.\ \ **Important Note:** Variances are not something to be taken negatively. It may increase healthcare costs due to the management of these variances that are outside of the clinical pathway, but over time as these variances become common and established a pattern, then it can be included in the clinical pathway depending on the institution\'s approval and analysis of the situation. If sooner or later it becomes part of the clinical pathway, then the health care costs will be controlled. Remember, the clinical pathways are not final. It always gets revised frequently depending on the institution, as our healthcare environment is dynamic. Collaboration within all members of the healthcare team is a must to ensure a smooth and proper implementation of these clinical pathways.\ \ See the sample documentation for further understanding of these variances.\ \ Sample Documentation Using Clinical Pathway\ \  **LESSON 2: Clinical Guideline**s **Clinical Guidelines** Clinical practice guidelines are statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence, and an assessment of the benefits and harms of alternative care options. CPGs should follow a sound, transparent methodology to translate best evidence into clinical practice for improved patient outcomes. Additionally, evidence-based CPGs are a key aspect of patient-centered care. Clinical practice guidelines should be developed using rigorous evidence-based methodology with the strength of evidence for each guideline explicitly stated. - Clinical practice guidelines should be feasible, measurable, and achievable. - Clinical performance measures may be developed from clinical practice guidelines and used in quality improvement initiatives. When these performance measures are incorporated into public reporting, accountability, or pay for performance programs, the strength of evidence and magnitude of benefit should be sufficient to justify the burden of implementation. - In the clinical setting, implementation of clinical practice guidelines should be prioritized to those that have the strongest supporting evidence, and the most impact on patient population morbidity and mortality. - Research should be conducted on how to effectively implement clinical practice guidelines, and the impact of their use as quality measures. The differences between Critical Pathway and Clinical Guidelines (Kumar, 2020) ------------------------------ ---------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ **Clinical Guideline** **Clinical Pathway** **Practice Protocol** **Focuses on** Specific Clinical Circumstances The quality and co-ordination of care Treatment **What is it?** Systematically developed statements to assist practitioners and patient make decisions about appropriate health care Structured, multidisciplinary plans of care. A suggested course of treatment and/or treatment service for a specific diagnosis, functional deficit or problem area. **What does it do?** Makes specific recommendations on health care and links these to research evidence. Supports the implementation of clinical guidelines and protocols. Highlights major therapeutic intervention points.\ Identifies choices of difference courses or paths of treatment.\ Suggests other diagnosis that could be considered as treatment progresses. **How does it work?** Provides a summary and appraisal of the best available research evidence or expert consensus.\ Provides detailed guidance for each stage in the management of a patient. Provides a logical flow of interventions.\ Highlights the strength of the evidence underlying each recommendation. Provides detailed recommendations that build on those made in guidelines. **Who uses it?** Clinicians/Medical Directors, patients and third parties A multidisciplinary clinical team. Specific clinicians/Medical Doctors with specialization. **Also known as...** Guidelines\ Integrated Care Pathways\ Protocol\ Clinical Practice Guidelines Multidisciplinary Pathways of Care\ Best Practice Treatment Protocol Pathways of Care\ Care Maps\ Collaborative Care Pathways **What are its components?** 1\) Appraisal of literature research evidence or expert consensus)\ 1\) Timeline\ 1\) List of major therapeutic interventions\ 2) Summary of recommendations.\ 2) Categories of care/interventions\ 2) Goals: When interventions should be achieved\ 3) An outline of how guideline should be implemented and how adherence 3) Intermediate and long term outcome criteria\ 3) Options for different choices of treatment\ monitored. 4) A variance record 4) Differential diagnoses and treatments based on the achievement of these goals ------------------------------ ---------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ **[E-JOURNALS]** **E-Journals** E-Journals or electronic journals are scholarly publications in digital form, which are accessible on the web. In the Philippines, we have the Philippine E-journals (ejournals.ph) where you can find an online bibliographic database & repository of academic journals in different disciplines various resources. These are often used as acceptable review of related literatures for research projects and evidence-based nursing practice. (See Unit 8- Informatics application in Research for the reliable search engines that you can use for research)  **TEACHER'S INSIGHTS\ ** In a nutshell, the computerized nursing care plan, the clinical guidelines of physicians, and other allied health care guidelines can be found on the clinical pathway as it promotes multi-disciplinary collaboration and coordination of patient care. **SELF-REFLECTION:** ***What will motivate you to promote or maintain confidentiality and privacy in your future profession?*** ***As a frequent user of internet and a social media user,*** *As a future health educator, how will you motivate your clients to adopt a healthy lifestyle form a bad lifestyle?*  **CHAPTER ACTIVITIES:** *You are assigned as a nurse informatics specialist of a new hospital which is likewise, about to venture into health information technology (HIT) through hospital management systems. you must also ensure that the patients' information encoded and shared are secured:* 1. *What are the differences between confidentiality, privacy and information security?* 2. *What are the factors to consider in information security?* 3. *What are the possible problems to be encountered in relation to the privacy and confidentiality of the patients' information? What are your recommendations to solve each of the problems?* **OpenMRS and Fitbi** --------------------- **A. OpenMRS and openEHR**\ 1. Open the OpenMRS Demo at https://openmrs.org/demo 2\. Click Launch Demo and choose InPatient Ward 3\. Click Register a Patient and key in your details 4\. Take screenshots or pictures of your encoded entries in your OpenMRS demo. Copy also the link of your demo version 5\. Compose a reflection paper by answering the following questions:\ a. Your insights with the use of electronic health records/hospital information system in the clinical practice\ b. How can we encourage our advance age nurses in using electronic health records (EHR)?\ \ **B. Fitbit and wearable technologies**\ Do you use an app or a website to track your exercise or eating? Do you use a wearable device for this like a Fitbit? Or do you use wearable device like Fitbit? What kind of data do these devices collect? What kind of charts/graphs do they display? Watch [**[Fitbit Flex Wireless Activity Tracker & Sleep Wristband - YouTube]**](https://www.youtube.com/watch?v=p8f78gp0rNQ)\ Read: [**[Keeping Up With Kristie: More Fitbit: Charts for the Visual Person (like me!)]**](http://keepingupwithkristie.blogspot.com/2014/03/more-fitbit-charts-for-visual-person.html)\ \ How might this data be useful to people?\ Does the way the data is displayed impact how useful it is? **REFERENCES:** **Saba, V. K., & McCormick, K. A. (2015). Essentials of Nursing Informatics (6^TH^ ed.). New York: McGraw-Hill Education** **Brixey, J. E., Brixey, J. J., McCormick, K. A., Saba, V. K. (2016). Essentials of Nursing Informatics Study Guide. McGraw-Hill Education\ \ Cu, N. (2021). Nursing Informatics: Textbook, Workbook and Study Guide (1^st^ ed). APD Educational Publishing House\ ** **CHAPTER 7: CLINICAL CARE CLASSIFICATION SYSTEM** ***[\ Intended Learning Outcomes:]*** ***After studying this chapter, the student is expected to:*** 1. Define CCC system 2. Identify the major features of CCC 3. Explain the application of CCC coding system 4. Code using the CCC system in a provided scenario **CLINICAL CARE CLASSIFICATION SYSTEM ** ---------------------------------------- **Clinical Care Classification (CCC) System** --------------------------------------------- - It was developed from a research study conducted by Dr[.] Virginia K Saba and a research team through a contract with Health care Financing Agency (HCFA), currently known as the Centers for Medicare and Medicaid Services (CMS) - A standardized, coded nursing terminology that identifies the discrete  elements of nursing practice[.] - The CCC provides a unique framework and coding structure[.] - It is used for documenting the plan of care; following the nursing process in  all health care settings[.] - Specifically designed for clinical information systems, the CCC facilitates  nursing documentation at the point-of-care[.] - The  CCC  was  developed empirically through the  examination of  approximately:       -40,000 textual phrases representing nursing diagnoses/patient problems,       -72,000 phrases depicting patient care services and/or actions**[.]** - The use of the CCC has expanded into other settings, and it is claimed to be  appropriate for multidisciplinary documentation[.] - It is an [[American Nurses Association]](https://en.wikipedia.org/wiki/American_Nurses_Association) (ANA)-recognized comprehensive,  coded, nursing terminology standard[.] In 2007, the CCC was accepted by the  Department of Health and Human Services as the first national nursing  terminology[.] - The computable structure of the CCC System allows nurses, allied health  professionals, and researchers to determine; care needs (resources),  workload (productivity), and outcomes (quality)[.] The CCC (capturing the essence of patient care) *consists of two interrelated terminologies:* -the CCC of Nursing Diagnoses & Outcomes -the CCC of Nursing Interventions & and Actions (Classified by 21 Care Components that link the two together**[.]**  This merge enables a roadmap to other health-related  classification systems**[.]**) History *1988 to 1990, [**[Harriet Werley]**](https://en.wikipedia.org/wiki/Harriet_Werley)* Established the Nursing Minimum Data Set, which consisted of 12  variables: 8 variables focused on patient demographics and the  remaining 4 focused on nursing practice[.] These were: (a)nursing diagnoses, (b)nursing interventions, (c)nursing outcomes, and (d)nursing intensity[.] The Nursing Minimum Data Set became the basis for the nursing  classification standards recognized by the ANA[.] *1991, the Database Steering Committee* Submitted to the Congress on Nursing Practice a resolution that NI  be adopted as a new nursing specialty[.] This submission which was  accepted, leading to the development of the Nursing Informatics:  Scope and Standards of Practice and the certification of NI  specialists[.] *1992, the Database Steering Committee* Developed the criteria, recognizing the first 4 of 12 nursing  classifications/terminologies[.] One being the CCC System[.]  Previously known as the Home Health Care Classification System,  as nursing standards for the documentation of nursing practice using  computer technology systems[.] The ANA subsequently submitted the  four  of  six classifications/terminologies to the National Library of Medicine  for input into its developing Unified Medical Language System's  (UMLS) Metathesaurus[.] *2006, President George W**[.]** Bush* Issued an Executive Order (No[.] 13410) that every person in the country  should have an EHR by 2014[.] *2007/2008, the Healthcare Information  Technology Standards Panel* selected and recommended the Clinical  Care Classification (CCC) System as the first national nursing  terminology inter operable for the exchange of information among HIT  systems[.] The CCC System was one of the standards in the first set of 55 national  standards approved for use in the EHR, by the Department of Health  and Human Services (AHIC, 2006) and the only national nursing  terminology standard[.] *2020, HCA Healthcare* Became the new custodian of Dr[.] Virginia Saba's Clinical Care  Classification (CCC) System[.] *Major features* - Consists of discrete atomic-level concepts using qualifiers to  enhance and expand the concepts[.] - Data are collected once and used many times for many purposes  including efficient aggregation[.] - Copyrighted and in the public domain; available with permission  without any cost or license[.] - Specifically designed for electronic health records (EHRs)  and healthcare information technology (HIT) systems as  well as other electronic information processing systems[.] - Tested and applicable in ALL healthcare settings[.] - Conforms to Cimino (1998) criteria for a standardized  healthcare terminology[.] Coded standardized framework  for electronic documentation, retrieval, and analysis[.] - Codes based on ICD-10 (WHO, 1992) structure for information  exchange promoting interoperability[.] - Uses a coding structure of five alphanumeric digits to link the two  CCC System terminologies to each other and to map to other  EHR/HIT systems[.] - Designed for determining workload (productivity), resources  (needs), outcomes (quality), and care costs[.] - Concept terminology with online source files so public and  private organizations may harmonize nursing information formats  for cross-organizational sharing of information[.] - Facilitates the electronic documentation of patient care at the point  of care[.] - Uses a framework of care components to classify the two CCC  System terminologies and represent 4 healthcare patterns focusing  on a holistic approach to patient care[.] - Consists of flexible, adaptable, and expandable concepts/data  elements[.] *The CCC Model* - Depicts the documentation of patient care by nurses and allied health  providers in any health care setting as an interactive, interrelated, and  continuous feedback process[.] - The CCC Model illustrates the relationship between the CCC of Nursing  Diagnoses and Outcomes and the CCC of Nursing Interventions and  Actions[.] The arrows are bi-directional indicating the continual flow and  feedback among the three major concepts: □Nursing Diagnoses □Interventions □Outcomes[.] *System framework* *Components:*\ A nursing care component is defined as a cluster of elements that represents a unique pattern of clinical care nursing practice; namely: Health Behavioral, Functional, Physiological, and Psychological. *Nursing Diagnoses:*\ A clinical judgment about the healthcare consumer's response to actual or potential health conditions or needs.  The diagnosis provides the basis for determination of a plan to achieve expected outcomes.  Registered nurses utilize nursing and medical diagnoses depending upon education and clinical preparation and legal authority" *Nursing Interventions:*\ A nursing intervention is defined as a single nursing action -- treatment, procedure or activity\ --designed to achieve an outcome to a diagnosis, nursing or medical, for which the nurse is accountable. Patient services are usually initiated as medical orders by a referring physician and reviewed by the admitting nurse. As part of the admission assessment the primary nurse also determines the nursing orders based  on the signs and symptoms, diagnoses, and expected outcomes/goals; and together, form the plan of care that requires the nursing interventions  following the nursing process. *\ \ \ Nursing Outcomes:* The CCC of Nursing Outcomes Version 2.5 consists of 528 concepts  derived from the three qualifiers used to modify the 176 Nursing  Diagnoses: Improve(d), Stabilize(d), or Deteriorate(d)**[.]** These three  qualifiers depict the Expected Outcomes and Actual Outcomes --totaling  528 nursing outcome concepts. The Expected Outcomes represent the goal of patientcare in future tense as will:\ -Improve, resolve patient\'s condition\ -Stabilize, maintain patient\'s condition\ -Deteriorate The Actual Outcomes represent whether the goals were met or not met  using the qualifiers in the past tense as:\ -Improved,\ -Stabilized,\ -Deteriorated CCC CODING - First position: One alphabetic character code for Care Component (A to U); - Second and Third positions: Two-digit code for a Core Concept (major  category) followed by a decimal point; - Fourth position: One-digit code for a subcategory, if available, followed by a decimal point; - Fifth position: One-digit code for: one of three Expected or Actual Outcomes  and /or; one of four Nursing Intervention Action Types The CCC: additional - The significance of the CCC is a nursing terminology that  completes the missing link needed to address nursing contribution  to healthcare quality[.] Nursing care may be the most critical factor in  a patient's treatment and recovery[.] The partnership of nursing and  technology is vital for designing nursing practice environments[.] - The benefit of the CCC is the ability to represent the essence of  nursing care in health information systems and applications during  any patient care, transfer or transition[.] - The CCC supports the mandate of accrediting organizations to reconcile patient-centered information (The Joint Commission,  2011) (http://www[.]jointco mmission[.]org) and supports the  informational exchange and data integrity requirements of CMS and  the Office of the National Coordinator (ONC) for meaningful use  when patient data is exchanged by using the Nurse Process  recognized for professional nursing[.] - Standardized professional documentation - Standardized data on nursing interventions for evidence-based  practice and research Re-usable health data for cross-organization  exchange comparisons - Documented outcomes by nursing diagnoses - Standardized quality outcomes comparisons by nursing intervention  and action type Applied uses Nursing Practice Applications: - Capture patient care data using a standardized coded nursing  terminology[.] Code electronic clinical encounters: diagnoses,  interventions, and outcomes[.] Track nurses' contribution to patient  care and care outcomes[.] - Provide standardized concepts (data/elements) for clinical pathways  and decision support[.] - Enable evidence-based practice protocols to process and analyze  patient care data and to evaluate the effects of nursing care on patient outcomes[.] Nursing Education Applications: - Teach students how to electronically document and code POCs  based on the nursing process[.] Track student assignments:  procedures and protocols[.] - Test and evaluate online the clinical documentation of student's  patient care[.] Teach and evaluate student use of simulations[.] - Use Second Life to enhance educational experiences[.] - Use the CCC System application to enhance nursing educational  experiences[.] Nursing Research Applications: - Search online nursing literature for nursing ontology and the  CCC System[.] - Research the use of relative value units and the CCC of Nursing Interventions/action Types [.]Analyze and interpret nursing output  in the EHR[.] - Support research to advance NI science and knowledge[.] Nursing Administration Applications: - Capture standardized quality indicators and measures[.] - Capture and measure the impact of care on outcomes[.] - Determine and measure nursing workload, resources, and cost[.] - Support the prediction of patient acuity and care needs[.] **CLINICAL CARE SYSTEM NURSING: CCC CODING** **CLINICAL CARE SYSTEM NURSING** **CCC CODING**  *Table 1* +-----------+-----------+-----------+-----------+-----------+-----------+ | CARE | NURSING | NURSING | | | | | COMPONENT | DIAGNOSES | INTERVENT | | | | | S | and | IONS | | | | | | OUTCOMES | and | | | | | | | ACTIONS | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ |   | Nx**[.]{. | Expected | Actual | Action | Nursing | | | underline | Outcomes | | | Intervent | | | }** Diagn | | Outcomes | Types | ions | | | osis | | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | | \* * | *To | *Improved | *Assess | \* * | | | | improve | (**[.]{.u | or | | | | \* * | (**[.]{.u | nderline} | Monitor | \* * | | | | nderline} | **1)* | (**[.]{.u | | | | *Nursing | **1)* | | nderline} | \* * | | | Diagnosis | | | **1)* | | | |  +* | | | | *+ | | | | | | | Nursing | | | | | | | Intervent | | | | | | | ion* | +-----------+-----------+-----------+-----------+-----------+-----------+ | | | *To | *Stabiliz | *Perform | | | | | stabilize | ed | or Care | | | | | (**[.]{.u | (**[.]{.u | (**[.]{.u | | | | | nderline} | nderline} | nderline} | | | | | **2)* | **2)* | **2)* | | +-----------+-----------+-----------+-----------+-----------+-----------+ | | | *Deterior | *Deterior | *Teach or | | | | | ation | ated | Instruct | | | | | (**[.]{.u | (**[.]{.u | (**[.]{.u | | | | | nderline} | nderline} | nderline} | | | | | **3)* | **3)* | **3)* | | +-----------+-----------+-----------+-----------+-----------+-----------+ | | | \* * | \* * | *Manage | | | | | | | or Refer | | | | | | | (**[.]{.u | | | | | | | nderline} | | | | | | | **4)* | | +-----------+-----------+-----------+-----------+-----------+-----------+ *Example: Expected Outcome      Activity Intolerance\-\-\-\-- To improve \-\-\-\-- A01**[.]**0**[.]**1* *Example: Actual Outcome         Activity Intolerance\-\-\-\-- Improved \-\-\-\-- A01**[.]**0**[.]**1* \* Example: Intervention              Teach Activity Care\-\-- A01**[.]**0**[.]**3* \* * *Table 2* +-----------------+-----------------+-----------------+-----------------+ | CARE COMPONENTS | DIAGNOSES | NURSING | | | | | INTERVENTIONS | | +-----------------+-----------------+-----------------+-----------------+ | A**[.]{.underli | (A01**[.]{.unde | A01**[.]{.under | A01**[.]{.under | | ne}**      ACTI | rline}**0) | line}**1\-\-- | line}**0\-\-- | | VITY | | Activity | Activity Care | | | ACTIVITY | Intolerance | | | | ALTERATION | | *(Activities | | | | *(Incapacity to | performed to | | | *Change in or | carry out | carry out | | | modification or | physiologic or | physiological | | | energy used by | psychological | daily | | | the body* | daily | activities)* | | | | activities)* | | | | \* * | | \* * | | | |   | | | |   | | A01**[.]{.under | | | | A01**[.]{.under | line}**2\-\-- | | | | line}**2\-\-- | Energy | | | | Activity | Conservation | | | | Intolerance | | | | | Risk | *(Actions | | | | | performed to | | | | *(Increase | preserve | | | | chance of an | energy)* | | | | incapacity to | | | | | carry out | \* * | | | | physiologic or | | | | | psychological | A02**[.]{.under | | | | daily | line}**0\-\-- | | | | activities)* | Fracture Care | | | | | | | | | \* * | *(Actions | | | | | performed to | | | | A01**[.]{.under | control broken | | | | line}**3\-\-- | bones)* | | | | Diversional | | | | | Activity | \* * | | | | Deficit | | | | | | A02**[.]{.under | | | | *(Lack of | line}**1\-\-- | | | | interest or | Cast Care | | | | engagement in | | | | | leisure | *(Actions | | | | activities)* | performed to | | | | | control a rigid | | | | \* * | dressing)* | | | | | | | | | A01**[.]{.under | \* * | | | | line}**4\-\-- | | | | | Fatigue | A02**[.]{.under | | | | | line}**2\-\-- | | | | *(Exhaustion | Immobilizer | | | | that interferes | Care | | | | with physical | | | | | and mental | *(Actions | | | | activities)* | performed to | | | | | control a | | | | \* * | splint, | | | | | cast**[.]{.unde | | | | A01**[.]{.under | rline}** or | | | | line}**5\-\-- | prescribed bed | | | | Physical | rest)* | | | | Mobility | | | | | Impairment | \* * | | | | | | | | | *(Diminished | A03**[.]{.under | | | | ability to | line}**0\-\-- | | | | perform | Mobility | | | | independent | Therapy | | | | movement)* | | | | | | *(Actions | | | | \* * | performed to | | | | | advise and | | | | A01**[.]{.under | instruct | | | | line}**6\-\-- | mobility | | | | Sleep | deficits)* | | | | Disturbance | | | | | | \* * | | | | *(Imbalance in | | | | | the normal | A03**[.]{.under | | | | sleep/ wake | line}**1\-\-- | | | | cycle)* | Ambulation | | | | | Therapy | | | |   | | | | | | *(Actions | | | | A01**[.]{.under | performed to | | | | line}**7\-\-- | promote | | | | Sleep | walking* | | | | Deprivation | | | | | | \* * | | | | *(Lack of a | | | | | normal sleep/ | A03**[.]{.under | | | | wake cycle* | line}**2\-\-- | | | | | Assistive | | | | | Device Therapy | | | | | | | | | | *(Actions | | | | | performed to | | | | | support the use | | | | | of products to | | | | | aid in caring | | | | | for oneself)* | | | | | | | | | | \* * | | | | | | | | | | A03**[.]{.under | | | | | line}**3\-\-- | | | | | Transfer Care | | | | | | | | | | *(Actions | | | | | performed to | | | | | assist in | | | | | moving from one | | | | | place to | | | | | another)* | | | | | | | | | | \* * | | | | | | | | | | A04**[.]{.under | | | | | line}**0\-\-- | | | | | Sleep Pattern | | | | | Control | | | | | | | | | | *(Actions | | | | | performed to | | | | | support the | | | | | sleep and wake | | | | | cycle)* | | | | | | | | | | \* * | | | | | | | | | | A05**[.]{.under | | | | | line}**0\-\-- | | | | | Musculoskeletal | | | | | Care | | | | | | | | | | *(Actions | | | | | performed to | | | | | restore | | | | | physical | | | | | functioning)* | | | | | | | | | | \* * | | | | | | | | | | A05**[.]{.under | | | | | line}**1\-\-- | | | | | Range of Motion | | | | | | | | | | *(Actions | | | | | performed to | | | | | provide active | | | | | and passive | | | | | exercises to | | | | | maintain joint | | | | | functioning)* | | | | | | | | | |   | | | | | | | | | | A05**[.]{.under | | | | | line}**2\-\-- | | | | | Rehabilitation | | | | | Exercise | | | | | | | | | | *(Actions | | | | | performed to | | | | | promote | | | | | physical | | | | | functioning)* | | | | | | | | | | \* * | | | | | | | | | | A06**[.]{.under | | | | | line}**0\-\-- | | | | | Bedbound Care | | | | | | | | | | \* * | +-----------------+-----------------+-----------------+-----------------+ | | | | | +-----------------+-----------------+-----------------+-----------------+   PLAN OF CARE *Table 3: Example of the CCC Systems' Coding Structure for a Nursing PoC* ----------------------------------------- -------------------------------------- ----------- Assessment Activity Component: (A) Nursing Diagnosis Physical Mobility Impairment: (A01.5) Expected Outcome: Patient's Condition (will) Improve: (A01.5.1) Planning: (provide 2 Core Intervention) Ambulation Therapy: (A03.1) Rehabilitation Exercise: (A05.0) Nursing Intervention: Teach Ambulation Therapy: (A03.1.3) Nursing Intervention: Perform Rehabilitation Exercise: (A05.0.2) Actual Outcome: Patient's Condition (has) Improved : (A01.5.1) ----------------------------------------- -------------------------------------- ----------- \*Aside from CCC coding, health practitioners and providers also use ICD10 codes for diseases and CPT codes for procedures and HCPC for other services and supplies and equipment. You may refer to related websites in the internet such as: [[www.icd10data.com]](http://www.icd10data.com) **CHAPTER 8:** **NURSING INFORMATICS ON INTERNATIONAL PERSPECTIVES\ \ *[Intended Learning Outcomes:]*** ***After studying this chapter, the student is expected to:*** 1. Discuss the different nursing informatics in the different regions in the world 2. Compare different nursing informatics in the world 3. Explain the importance of applying nursing informatics in the Philippines  ---------------------- - The Canadian Nurses Association  (CNA) has taken the position that  "registered nurses and other stakeholders in healthcare delivery require information on nursing practice and it relationship  to client outcomes[.] - Nurses must be able  to manage and process nursing data, information, and knowledge to  support patient care delivery in diverse care delivery settings (Graves & Corcoran, 1989)[.] - There is an  essential linkage among access to information, client outcomes and patient safety[.] "As  Lang has succinctly and aptly  described the present situation: If  we cannot name it, we cannot  control it, finance it, teach it,  research it or put it into public  policy" (Clark & Lang N[.], 1992)[.]  A coordinated system to collect, store and retrieve nursing data in Canada is  essential for health human  resource planning and to expand knowledge and research  on determinants of quality nursing care... CNA believes that registered  nurses should advocate and lead in implementing the collection, storage and retrieval of nursing data  at the  national  level[.]" (Canadian  Nurses Association 2001) - Focus of NI in Canada is the role of nursing within healthcare organization[.] In most HC organizations, nurses manage both  patient care and patient care units within organization[.] Usually nurse  clinicians manage patient care and  nurse managers administer the  patient care units within the  organization[.] Therefore, for some  time, nursing's role in the  management of information has  been considered to include both  the information necessary to  manage patient care using nursing process and the information necessary  for managing patient care units within the organization[.] Canadian Institute for Health Information - The establishment of the National Health Information Council in the  late 1980's lead to the National  Task Force on Health Information,  also known as the Wilk Task Force, which presented comprehensive  goals and a strong vision for a nationwide health information  system[.] - CIHI is an independent, national, not for profit organization,  established jointly by federal and provincial/ territorial ministers of  health[.] - During the decade of its existence  CIHI has become an acknowledged and trusted source of quality, reliable and timely aggregated health information for use in understanding and improving the management of the Canadian health systems and the health of the population of Canada[.] - Standards Council of Canada *The Canadian Advisory Council (CAC) on Informatics Health (Z295) advises the Canadian Stands Association (CSA).* Canadian Organization for the Advancement of Computers in Health or COACH - founded in 1975, has  actively initiated professional protocols for using computer systems in Canadian health care**[.]**  *The Canadian Nursing Informatics Association* In  2001,  a  new  group,  the Canadian Nursing Informatics Association (CNIA) received emerging group status from the  CNA and affiliate status in 2003. The CNIA now has full associate  status with the CNA**[.]** The mission of the CNIA is to be  the voice for Nursing Informatics in  Canada**[.]** Recognizing the  importance of the work the CNIA is  undertaking, the Canadian Nurses Association has granted associate  group status to the CNIA**[.]** *\ The Canadian Nurses Portal Project, NurseONE, E-Nursing Strategy* In 2006, the Canadian Nurses  Association launched the Canadian  Nurses Portal Project, shortened to NurseONE to address this vision, in  the form of a e-nursing strategy. "The purpose of the e- nursing strategy is to guide the development of ICT initiatives in nursing to improve nursing practice and client outcomes" (Canadian Nurses Association,  2006, p. 7). *OBSTACLES TO EFFECTIVE  NURSING MANAGEMENT OF  INFORMATION IN CANADA* 1.In Canadian health care delivery organizations, like hospitals and  health care agencies in other  countries, the major obstacles to  more effective nursing  management of information are: -the sheer volume of information, -the lack of access to modern  information handling techniques  and equipment, -and the  inadequate  information  management infrastructure. 2. Antiquated manual information  systems and outdated information  transfer facilities are information  redundant and labor intensive to say nothing of an  inappropriate use of an expensive  human resource, that is to say  nursing time and energy. 3.   Software and hardware for modern electronic communication  networks are only two aspects of  an information infrastructure. The  other major aspect is lacking in  most hospitals and health services  organizations, that is, the absence  of appropriate infrastructure to  facilitate information management.  Infrastructure includes but is not  limited to: -data management  policies and procedures, -methods  for data stewardship and custodianship, -user training and  information management support  staff. Support staffs are necessary to support nurses in appropriately  analyzing and interpreting  aggregated information. CANADIAN INITIATIVES DIRECTED AT THE DEVELOPMENT OF NURSING COMPONENTS OF HEALTH INFORMATION (HI:NC) In Canada nurses are in the  fortunate position of recognizing  the need for nursing data elements  at the time when the national  health infrastructure is under  development**[.]** To prevent nurses in  Canada from losing control of  nursing data, nurses must take a  proactive stance and mobilize  resources to ensure the development and implementation of a national health data base and a pan- Canadian EHR that is  congruent with the needs of nurses  in all practice settings in Canada**[.]** **\ Lesson 2: Nursing Informatics in Asia** **Since computers were first introduced into the health into the healthcare sectors of Asian countries in the 1970\'s. there have been exciting developments in healthcare informatics associated with the rapid growth in information and communication technology. The first applications of information technology in healthcare in Asian countries were in administration billing and insurance. Now these countries are moving toward implementing paperless electronic health records.** **NI have varied between Asian countries, but all governments have played a very important role in introducing information technology into the healthcare sector by providing funds, developing infrastructure and introducing policies to promote its use. Professional organization have also played an important role.** **The adoption of informatics in Asian countries usually began as a vision by a group of individuals in the government or a professional organization, who promoted the use of information technologies to support nurses in all areas of nursing practice.** **As information technology has become indispensable to daily activities of healthcare professionals. more and more nursing schools are beginning to realize the importance of providing informatics courses to nurses.** **Basic computer literacy education is now a part of nursing education in most Asian countries, and graduate programs majoring in NI are also available now in some countries, such as south Korea and Taiwan.** **Reports of research into NI began to appear in the domestic Asian nursing journals in 1990\'s, but such research is still in its infancy. In most countries, information technology first appeared as an educational tool, following by its use in clinical practice in applications such expert systems and electronic nursing records. This use in clinical practice lead to the development of standards becoming a favorite research topic.** **Events external to the nursing profession catalyzed the adoption of informatics links have assisted these begining and their progression. The progress in japan, China, and South Korea has been expedited by the hosting of the International Medical Informatics Association (IMIA) triannual conference in 1980, 1989, and 1997 respectively.** **the formation of the Asia Pacific Medical Informatics Association in 1993 helped launch national healthcare informatics association in China, Japan, South Korea, and Thailand due to the hosting of triannual conferences in the Pacific Rim. The China, Japan, and Korea Medical Informatics Association (formed in 1999) organizes conferences, seminars and workshops once a year and creates forums by for the sharing of experience and knowledge among both experts and users in these three countries. Asian nurses who are interested in promoting Informatics to their profession need to link out with this network.** ** ** **NURSING INFORMATICS IN KOREA\ \ South Korea compress eight provinces with seven metropolitan cities and the total population was about 47 million in 2002.** **The population is predominantly in urban areas, with 21% living within the Seoul metropolitan area.** **There are currently 190,720 licensed midwives and nurses of whom 81,478 are practicing and 23,331 of these are situation the Seoul metropolitan area. Health Informatics in South Korea has growth considerably in recent years professional outreach activities.** **In the contrast, computers were not used in nursing education and research in 1993 and NI was not taught in universities until 1994. In 1993, The Nursing Informatics, special interest group was organized in the KOSMI, since the nursing informatics group has held its own session at the biannual conferences of the KOSMI.\ ** **Nursing has been highly visible in the KOSMI by the presentation and publishing of papers on the used of computers in nursing of these conferences and in the journal of the KOSMI.** **the IMIA conference MIDINFO98, held in Seoul provided an excellent opportunity for Korean nurses to become acquainted by NI.** **Currently there are modern 200 active nurse members in the KOSMI of 1000 active members.** **Further momentum for NI has been coming from funding for a NI study group provided by the Korean science and engineering foundation since 1998.** **Activities of the study group include journal reviews and research activities such as survey studies of NI education and computer applications in nursing practice in Korean hospitals.** **Korean nurses have attended and participated in many international conferences promoted or supported by IMIA or IMIA-NI group since 1989.** **Korean Nurses represented the country at the IMIA-NI group of 1995, since then Korea has sent a representative to the group and participated actively in developing and furthering NI.** **\ ***Use of Information Technology in Clinical Practice* **According to the report published by the Korea Health Industry Development Institute in 2000,100% of teaching hospitals, and 75% of private clinics now have hospital information systems (Korea Health Industry Development Institute,2000). Such a high implementation rate is believed to have been initially driven by financial factors associated with medical insurance claims, with the focus subsequently shifting to all areas of patient care when clinicians began to use computers in their practice. A recent study shows that all of the teaching hospitals and about 40% of general hospitals in Korea are using order Communication systems (Kwak 2000), which enable physicians to communicate with other departments for practiced -related requisitions and the retrieval of data. In addition, about 95% of teaching hospitals and 20% of general hospitals are equipped with pictures archiving and communication system(PACS\'s). There has been a great deal of interests among healthcare organizations in acquiring the system since the government announced high reimbursement rates for diagnostic radiology examinations using PACS in 2000, and PACS are now one of the most common information technology systems in South Korea hospitals. Hospitals in South Korea are now beginning to implement paperless electronic medical record systems.** **The use of computers in clinical nursing practice in Korea began first in medium-sized hospitals. These hospitals initially used computers mainly for administration and billing, as did most hospitals in other countries, but later a patient-care component was added. These systems allowed physician to enter medical orders directly into the computers, and major ancillary department could receive requisitions and enter test results. The nurses work list could be viewed on screen or printed so that the nurses did not need to copy medication schedules or care activities into the cardex or write paper messages.** **Other Korean hospitals were also pursuing this level of automation. Nursing information system proliferated when large hospitals ( with more than 1000 beds) began opening in the mid-1990\'s. These new hospitals were equipped with nursing information systems when they first opened. They included unique nursing activities such as nursing assessments, nursing care plans, and patient classifications, in addition to nursing activities related to billing, managerial and coordinating activities and physician delegated tasks.** **A home healthcare system for community-based clinical practiced was developed by the Home Healthcare Team at the College of Nursing, Seoul National University (Park et al.,2000).Home healthcare nurses use laptop computers to note and check medication and progress in electronic patient records,and to communicate electronically with other home healthcare team members.** **\ *Health Information Education*** **As information technology has become indispensable in healthcare and its impact on the daily activities of healthcare professionals has become significant, schools are beginning to realize the importance of health informatics education for clinicians. According to the recent surveys on health informatics and computer education programs in South Korean medical and nursing schools, about 25% of medical schools and 21% of nursing schools offer health informatics courses, while the remainder offer introductory computer courses (Park, 2002). The course contents vary a great deal from school to school, and the instructors are mostly self-taught in these subjects. This indicates that there is a a need for standardization of health informatics courses for baccalaureate programs based on tasks of healthcare professionals, together with graduate programs to produce qualified health informatics educators.** **Most nursing schools in Korea are adding informatics to graduate curricula so that graduate students can take informatics courses as an elective. The graduate specialization program in NI in Korea was first introduced at Seoul National University in 2001. This program is the only one in Korea that awards a master\'s degree in NI.** **\ *Research*** **Most papers presented at KOSMI conferences and published in the Journal of the KOSMI since 1991 have addressed the application of commercially available programs, with more recent papers discussing the use of computers as the total for nursing education. Distance education using the Internet has also been described (Park, Cho and Kim,1998;Cho and Park,1998; Kim et al.,2000; Choi et al.,199. The trend toward system integration in the health industry in the late 1990\'s lead to more articles and presentations on standardization. Papers on the standardization of nursing vocabulary and nursing documentation forms have also appeared (Park et al., 1999; Park and Cho, 2000; Coenen et al.,2001).** **Another popular research area is the use of artificial intelligence in nursing diagnosis (Park, Lee and Song,1995; Kim 1998; Yoo et al.,1998). The use of personalized digital assistants (PDAs) in hospital and home health-care settings along with the standardization and the use of Web-based electronic patient records and current areas of interest (Hyun et al.,1999, Cho and Park ,2003).** ** ** ***Standardization Activities*** **\ There are current efforts to implement a single, integrated healthcare and nursing terminology in South Korea, the primary motivation for which is compatibility of data, clinical documentation, and research outcomes across the country. There are Korean representatives actively involved in international initiatives toward this end, such as International Organization for Standardization/ Technical Committee 215 (ISO/TC215) and Health Level Seven (HL7).** **Administrative information systems in the healthcare sector essentially use the Koren Standard Classification of Diseases (the Korean version of the International Classification for Disease \[ICD\]10), while clinician information systems are beginning to use more concept -oriented terminology such as the SNOMED (Systematized Nomenclature of Medicine). The majority of existing nursing terminologies, such as the North American Nursing Diagnosis Association (NANDA) Taxonomy 1 and 2, Nursing Interventions Classifications (NIC), Home Healthcare Classification (HHCC), the Omaha system, Nursing Outcomes Classification (NOC), and International Classification for Nursing Practice (NCP), have been translated into Korean and standardized. Among these terminologies, the NANDA is the most frequently used in nursing education, and the 3N (NANDA, NIC-NOC) and INCP are most frequently used in clinical practice for electronic nursing record systems in Korea.** **\ *\ \ Government Initiatives*** **The Korean government has contributed to the development of health informatics by providing funding or other incentives and guidelines in telemedicine, emergency medical systems, infectious diseases reporting systems, and standardization. The Korean government has contributed to the implementation of a nationwide information highway, with the Ministry of Information and Communication having funded information, highway projects since the early 1990\'s. There are two information highways available;(1) the South Korea Advanced Research Network, which is mainly used for research activities and (2) a nationwide commercialized network built by telecommunication companies (Korea Ministry of Information and communication,2002). These network interconnect 12 metropolitan areas in South Korea at 622 Mbps and smaller surrounding cities are connected at 155 mbps. Individual users at their home can use ADSL (asynchronous digital subscriber line) to connect to the Internet at a speed of 1-8 Mbps, and currently more than 50% of South Korean homes have ADSL connections. This is highest percentage among all countries of the world.** **The Korean Ministry of Health and Welfare established a long-term plan for national health and welfare network (NHWN)in 1993. The NHWN cover six areas; public health, hospitals and clinics, health insurance, food and drugs, national pension, and health and welfare administration. Public health was selected as the top-priority project in 1994, to be carried out in the three phases;** ** ** **The first phase (form 1994-1997) computerized the administrative and patient-care activities of health centers.** **The second phase (from 1998-2001) developed infrastructure for the public health network, integrating network systems among health centers, health subcenters, and primary healthcare posts. An electronic data interchange system between the public healthcare facilities and the health insurers was developed for health insurance claims. Possible ways of linking the NHWN to the city, country, and district networks of the Ministry of Governmental Affairs and Home Affairs were studied.** **The current third phase, which started in 2001, involves the development of data warehousing at the level of major cities and provinces. Once this system is implemented successfully, it will be expanded to the whole of South Korea.** ** ** ***Professional Outreach\ *** **Since its foundation in1987, the KOSMI has played a very important role in promoting and developing health informatics by holding biannual academic conferences, various seminars , workshops, and open forums, and by publishing journals. KOSMI has also offered educational programs for beginners in health informatics.** **Organization such as the Korean medical Association and the Korean Nurses Association have also played a significant role by including health informatics in their continuing education programs. Another healthcare informatics expert group, the Health Informatics Standardization Committee, serving as the South Korean technical advisory group of the ISO/TC215, has held open forums and published health information standards.** **The IMIA has contributed significantly to furthering the knowledge of South Korean healthcare professionals about worldwide trends in health informatics. These individuals have attended and participated in many international conferences promoted or supported by the IMIA since 1989.** **\ *Technology Trends*** **\ The rapid growth in the number of mobile telephone users (currently estimated to be around 65% of the total population) and the advance in wireless local area network (LAN) technology have led to mobile computing in healthcare bec