NCM 221 1st Unit PDF

NCM 221 1st UNIT COURSE OUTLINE: Computers and Nursing -History -Integration of Computers in Nursing Practice -Computers and System -Computer Hardware and Software An Overview -Data Assessment -Personal, Professional, and Educational Informatics Information and Technology Systems: A D...

NCM 221 1st UNIT COURSE OUTLINE: Computers and Nursing -History -Integration of Computers in Nursing Practice -Computers and System -Computer Hardware and Software An Overview -Data Assessment -Personal, Professional, and Educational Informatics Information and Technology Systems: A Dependable System for Quality Care -Applications of Nursing Informatics in the different facets of Nursing Practice -Clinical,Critical, and Hospital Perspective -Community and Public Health -Ambulatory Care Systems -Emergency Preparedness and Risk Response -Telehealth: An approach to unified and accessible health care for all -General Workplace Technology and Administrative Applications Computers and Nursing In 1863, Florence Nightingale noted the importance of information to improve healthcare. In Notes on a Hospital, she wrote, “I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison.” Her efforts to correct this oversight highlighted the value in systematically collecting information on healthcare practices and outcomes and served as a critical turning point in healthcare generally, and the professionalization of nursing in particular. Nightingale recognized that information, collected systematically, was necessary to “show the subscribers how their money was being spent, what good was really being done with it, or whether the money was not doing mischief rather than good” (Nightingale, 1863). Two hundred years later, nurses and other clinicians are still attempting to find the information that they need to support clinical decision-making.  Florence Nightingale has been credited as one of the first statisticians to collect and use data to change the way she cared for her patients. While serving in the Crimean War, she began to gather data regarding the conditions in which patients were living and the diseases they contracted and from which they died. These data were later used to improve patient conditions at both city and military hospitals (O’Connor & Robertson, 2003). Perhaps she could be called the first informatics nurse because she used analytical methods to manipulate data to understand how to care for patients. The term Nursing Informatics was coined by Scholes and Barber in 1980. Maureen Scholes, a nurse practitioner and nurse manager, was a pioneer and a very enthusiastic in the field. She participated at the first MEDINFO in 1974 presenting a paper. Years later she was the chair of the First International Conference on Nursing Informatics that was held in London, England in 1982. As Virginia Saba, a NI pioneer, explained, the flow of information “starts with the nurse, who collects data as she provides service to the patient. The data are then transferred to the reporting system, where they can be translated into information of significant value to all components of the agency and all levels of personnel” (Saba, 1974). What Is Nursing Informatics? The ANA’s Nursing Informatics: Scope and Standards of Practice (2015) offers the following definition of NI: Nursing informatics (NI) is the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge and wisdom in nursing practice. NI is a nursing specialty that does not focus on direct patient care but instead focuses on enhancing patient care and safety and improving the workflow and work processes of nurses and other healthcare workers. The INS (Informatics Nurse Specialist) is instrumental in designing the EHRs (Electronic Health Record) that healthcare workers use on a daily basis. This nurse is also responsible for designing tools that allow healthcare workers to access patient information more efficiently than they have been able to do in the past. Principles of Nursing Informatics: The following principles of nursing informatics form a framework that characterizes the thinking and actions of informatics nurses in all aspects of practice and in every setting. Nursing informatics: Has a unique body of knowledge, preparation, and experience that aligns with the nursing profession. NI incorporates informatics concepts in specific application to the role of nursing and nurses in the healthcare continuum. Involves the synthesis of data and information into knowledge and wisdom. Supports the decision-making of healthcare consumers, nurses, and other professionals in all roles and settings to achieve healthcare consumer safety and advocacy. Supports data analytics, including quality-of-care measures, to improve population health outcomes and global health. The IN and INS understand that the real-time application of accurate information by nurses and other clinicians is a mechanism to change healthcare delivery and affect patient outcomes.  Promotes data integrity and the access and exchange of health data for all consumers of health information. Supports national and international agendas on interoperability and the efficient and effective transfer and delivery of data, information, and knowledge. Ensures that collaboration is an integral characteristic of practice. Interleaves user experience and computer–human interaction concepts throughout practice. Incorporates key ethical concerns of NI such as advocacy, privacy, and assurance of the confidentiality and security of data and information. Considers the impact of technological changes on patient safety, healthcare delivery, quality reporting, and the nursing process. Leads in the design and promotion of useful, innovative information technologies that advance practice and achieve desired outcomes.  The American Nurses Association’s Nursing Informatics: Scope and Standards of Practice, 2nd edition (2014) gives two titles for nurses working in informatics: “informatics nurse” and “informatics nurse specialist.” The informatics nurse (IN) is a registered nurse with an interest or experience in an informatics field, such as nursing informatics. The informatics nurse specialist (INS) is a registered nurse with formal, graduate-level education in informatics or a related field. Purpose: Enhance efficiency, improve patient outcomes, and support evidence-based practice. Nursing Informatics Competencies by Skill Level: HISTORY: Nursing informatics was first introduced in the 1950s in parallel with the integration of computers into healthcare facilities. At that time, computers were used to collect and handle patient data. According to Ozbolt and Saba (2008), one very early pioneer, Harriet Werley, a nurse researcher at Walter Reed Army Research Institute, consulted with IBM in the late 1950s to explore computer use in health care. Ms. Werley recognized the need for a minimum set of data to be collected from every patient so that comparisons could be made, which set the stage for the development of informatics. Harriet H. Werley practiced as a nurse informatician before informatics was named and acknowledged as a field in nursing (Ozbolt, 2003). In the 1960's, the development of hospital information system for financial transactions started. Computers were beginning to be used in healthcare (Saba, 2001). For example, the United States began to use computer systems to process standardized reimbursement forms with the passage of the Medicare legislation in 1966 (Saba, 2001). The nursing profession began to embrace and utilize informatics principles. During the 1960's, a nurse created an obstetrical computer-assisted nursing simulation exercise (Saba, 2001). In 1970's, nurses assisted in the design of HIS. Computers are used in financial and management functions, and several communities developed management information system. The "informatics movement" was felt throughout all disciplines of health care both nationally and internationally (Saba, 2001). Nursing stations were studied and identified to be central to patient care and deemed fundamental in the creation of health information systems (HIS) (Saba, 2001). The adoption of some of the first HIS and Electronic Medical Records (EMR) occurred in the 1970's (Thede, 2012). By 1974 the first nursing informatics papers were presented at the Medical Informatics Conference in Sweden (Saba, 2001). Carol Romano, a nurse with a Masters and PhD in Operations Analysis and Informatics, designed and implemented one of the first computerized medical information systems in 1976. and was co-architect of the world’s first graduate curriculum in nursing informatics at the University of Maryland. In the 1980's, Nursing informatics gained recognition as a specialty, marked by advancements in health informatics and the introduction of nursing-focused systems (An Introduction to Nursing Informatics, 2018) There were significant financial investments and a big educational push to educate nurses in informatics (Norris & Brittain, 2012; Saba, 2001). And by 1985, computer technology classes were being offered at undergraduate and graduate levels (Saba, 2001). Zielstorff's "Computers in Nursing" (1980) was the first book to address nursing informatics, and by 1982, the First International Conference on Nursing and Computing was held in the UK. The International Medical Informatics Association (IMIA) recognized nursing as integral to the future of healthcare technology, and by 1989, the International Council of Nurses (ICN) supported the development of a common informatics language. In the mid-1980s, Blum (1986) introduced the concepts of data, information, and knowledge as a framework for understanding clinical information systems and their impact on health care. Blum classified clinical information systems according to the three types of objects that these systems processed: data, information, and knowledge. In 1989, Graves and Corcoran built on these ideas in their study of nursing informatics using the concepts of data, information, and knowledge. They contributed two general principles to NI: a definition of nursing informatics that has been widely accepted in the field, and an information management model that identified data, information, and knowledge as key components of NI. In the 1990's, computer technology became an integral part of the healthcare setting. In 1992 the American Nursing Association (ANA) recognized nursing informatics as nursing specialty (Saba, 2001). By 1995, the first NI credentialing exam was offered by the ANA (Saba, 2001). In the 25+ years since its recognition, NI has spread and flourished, influencing every aspect of the U.S. healthcare landscape. Today, nurse informaticists can be found at bedside, in information technology (IT), and in government at the local and federal levels. The scope and standards of this profession, updated every five years, have also grown in order to meet the opportunities and challenges of a healthcare landscape continuously shifting and adjusting to the array of new technologies and regulations. In 1999 the International Council of Nurses (ICN) created a program to expand the scope of practice and advance nursing knowledge worldwide (Saba, 2001).  And in the year 2000, Clinical Information System became individualized in the electronic patient record, mobile computing device were introduced, new technologies were utilized, internet provided new means of development and Health Insurance Portability and Accountability Act of 1996 was enacted (HIPAA is a United States legislation that provides data privacy and security provisions for safeguarding medical information.) What is a Clinical Information System? Clinical Information System (CIS) is common to modern health care and is a computer-based system that is designed for collecting, storing, manipulating and making available clinical information important to the healthcare delivery process. These systems may be used at single locations or across entire healthcare systems.  Clinical Information System can be used interchangeably with Electronic Information Systems computerized patient and electronic medical record (EHR). It refers to a set components that form the mechanism by which patient records are created, used, stored and retrieved usually located within a healthcare provider setting. It includes people, data rules and procedures, processing and storage devices, communication and support facilities (institute of Medicine, 1991). A CIS is designed to support clinical nursing practice. It requires not only an understanding of professional nursing practice process but also technology that is the application for the science to function electronically. The increased interest in NI occurred because of the concerted efforts of several groups that promoted nursing as an integral part of the EHR systems being implemented in healthcare. Individual nurses began to demand CIS to document their care, regardless of where they worked and the vendors of the EHR systems began to include nursing care components in their systems. Integration of Computers in Nursing Practice: A computer is an electronic information processing machine that serves as a tool with which to manipulate data and information. The easiest way to begin to understand computers is to realize they are input–output systems. These unique machines accept data input via a variety of devices, process data through logical and arithmetic rendering, store the data in memory components, and output data and information to the user. The computer is the most powerful technological tool to transform the nursing profession prior to the new century, and the computer has transformed the nursing paper-based record to computer-based record. Computer is an all-encompassing term referring to information technology (IT), computer systems, and when they are used in nursing, refer to nursing informatics systems, nursing applications. They are used to manage information in patient care, monitor the quality of care, and evaluate the outcomes of care. Computers are also used to support nursing research, test new systems, design new knowledge databases, and advance the role of nursing in the health care industry. Tools and methods from information and computer sciences are fundamental to NI, including: Information management—An elemental process by which one files, stores, manipulates, and reports data for various uses. Information communication—Enables systems to send data and to present information in formats that improve understanding. Information structures—Organize data, information, and knowledge for processing by computers. Information technology—Includes computer hardware, software, communication, and network technologies, derived primarily from computer science. Its use distinguishes informatics from more traditional methods of information management. Computer science offers extremely valuable tools that, if used skillfully, can facilitate the acquisition and manipulation of data and information by nurses, who can then synthesize these into an evolving knowledge and wisdom base. This process can facilitate professional development and the ability to apply evidence- based practice decisions within nursing care, and if the results are disseminated and shared, can also advance the professional knowledge base. Four Major Nursing Areas: Computers and Systems Computer hardware  Computer Hardware: refers to the actual physical body of the computer and its components. Several key components in the average computer work together to shape a complex yet highly usable machine that serves as a tool for knowledge management, communication and creativity. Basic hardware: – Electronic circuits – Microchips – Processors – Motherboard Includes devices that are peripheral to the main computer box such as input and output devices.  Computer hardware fundamentals: MOTHERBOARD A thin, flat sheet made of a firm, non conducting material on which the internal components-printed circuits, chips, slots of the computer are mounted. has been called the “central nervous system” of the computer because it facilitates communication among all of the different computer components. This makes it a key foundational component because all other components are connected to it in some way (either directly via local sockets, attached directly to it, or connected via cables). This includes universal serial bus (USB) controllers, Ethernet network controllers,& integrated graphics controllers. Computer hardware fundamentals: CENTRAL PROCESSING UNIT (CPU) is an older term for the processor and microprocessor. Sometimes conceptualized as the “brain” of the computer, the processor is the computer component that executes, calculates, and processes the binary computer code (which consists of various configurations of 0s and 1s), instigated by the operating system (OS) and other applications on the computer. Consists of at least one arithmetic and logic unit and memory. – the arithmetic and logic units control mathematical functions. – the control unit carries out the machine language functions called fetch, execute, decode and store. Computer hardware fundamentals: Memory 2 types: – ROM (Read Only Memory) – RAM (Random Access Memory) Read Only Memory (ROM) ROM refers to permanent memory. It's non-volatile, so when it loses power, the data remains. Generally contains the programs called firmware, used by the control unit of the CPU to oversee computer functions. Random Access Memory (RAM) Refers to working memory used for primary storage. Volatile and used as temporary storage - can be accessed, used, change and written on repeatedly. Contains data and instructions that are stored and processed by computer programs called applications programs. The contents are lost whenever the power of the computer is turned off. Computer hardware fundamentals: Input and output Input devices – allow the computer to receive information from the outside world. – e.g. keyboard, mouse, touch screen, light pen, voice and scanner  Output devices Allow the computer to report its results to the external world. Can be in the form of text, data files, sound, graphics or signals to other devices e.g. monitor and printer Computer hardware fundamentals Storage media Common storage devices: – Magnetic storage media Hard drive Diskettes – Optical storage CD-ROMs * Optical media are read by a laser “eye” rather than a magnet.  Hard drive and diskettes Hard Drive a peripheral that has very high speed and high density. a very fast means of storing & retrieving data as well as having a large storage capacity in comparison with the other types of storage. Diskettes a round magnetic disk encased in a flexible or rigid case. it allows the user to transport data & programs from one computer site to another. CD Roms and USB Disk CD-ROM – a rigid disk that hol ds a muc h higher density of information than a diskette & has a much higher speed. USB disk – a small removable hard drive that is inserted into the USB port of the computer. – a read-write device like floppies & small enough to transport comfortably in a pants pocket. Computer hardware fundamentals: Other output devices Magnetic tape drives – In 1980 & early 1990s were a popular way to back up hard drive data Zip drives – More similar to ordinary floppy disks but are of higher capacity Computer speed Processor speed, also known as clock speed or CPU speed, is a measure of how many cycles a CPU can execute per second. It's typically measured in gigahertz (GHz). For example, a CPU with a clock speed of 3.0 GHz can process 3 billion cycles per second. 2.5 GHz to 3.5 GHz is good for everyday use. 3.5 GHz to 4.0 GHz is great for gaming and more demanding tasks.  Classes of computers: Analog computers Operates on continuous physical or electrical magnitudes, measuring on going continuous analog quantities such as voltage, current, temperature & pressure. Accepts input/output signals e.g. heart monitors & fetal monitors.  Classes of computers: Digital computers Operates on discrete discontinuous numeral digits using the binary numbering. Data are represented by numbers, letters & symbols rather than by waveforms. Classes of computers: Hybrid computers Features of both the analog & the digital computer. Used for specific application such as complex signal processing & other engineering oriented applications. e.g. physiologic monitors that are able to capture the heart waveform & also to measure the core body temperature at specific times i.e. ECG,EEG  Types of Computers: Supercomputers Each type was developed as the computer industry evolved & each was developed for a different purpose. Supercomputers (high-end computers) – largest type of computer – computational-oriented computer specially design for specific applications requiring gigantic amounts of calculations – used by the aerospace, petroleum, and automotive industries. In addition, supercomputers have found wide application in areas involving engineering or scientific research.  Types of computers: Mainframes Fastest, largest & most expensive type of computer used for processing, storing, & retrieving data. In banking, finance, health care, insurance, utilities, government, and a multitude of other public and private enterprises, the mainframe computer continues to be the foundation of modern business.  Types of computers: Microcomputers Microcomputers (Personal Computer or PCs) – can serve stand-alone workstations & can be linked to a network system to increase their capabilities. – It is typically used for tasks such as word processing, internet browsing, email, multimedia playback, and gaming. Types of computers: Handheld Computers Small, special function computer. used logistics industry, manufacturing and retail industries. can include calendar software, task management software, word processing software, games, and MP3 music players, – e.g. PDAs (personal digital assistant)– can have calendar, contacts, note- taking, word processing, spread sheet, dictionary  A tablet is a wireless, portable personal A smartphone is a handheld device that computer with a touchscreen interface. functions as a portable computer and offers The tablet form factor is typically smaller the same features and capabilities you'd expect from any computer including access to than a notebook computer, but larger than the internet, ability to run applications, play a smartphone. media, take photos and videos, & communicate with other devices.  Basics of computer network hardware Network - a set of cooperative interconnected computer for the purpose of information interchange. – includes : LAN, WAN, MAN The most important components of network hardware are the adapter or interface card, cabling & server. The most important concepts in network hardware are architecture & topology.  LAN means local area network. WAN means wide area network. LANs connect users and applications in close geographical proximity (same building). WANs connect users and applications in geographically dispersed locations (across the globe). A metropolitan area network (MAN) is a computer network that connects computers within a metropolitan area, which could be a single large city, multiple cities and towns, or any given large area with multiple buildings. A MAN is larger than a local area network (LAN) but smaller than a wide area network (WAN). For example, if the router is being set up within an office, a LAN connection would be more appropriate. On the other hand, if the router is connecting an entire network of computers across a large area, a WAN connection would be the better choice.  Network Hardware The role of hardware in a network is to provide an interconnection between computers. It must have at least 2 pieces of hardware: – NIC – Network Adapter or Network Interface a computer circuit board or card that is installed in a computer so that it can be connected to a network. – Communication medium (cabling) the means by which actual transfer of data from one site to another takes place.  Network Hardware Choice of communication medium is based on the following: – Distance – Amount of data transfer – How often the transfer is needed – Availability Telephone lines communication Specialized phone lines called integrated services digital network (ISDN) lines are used to carry communication across phone lines. ISDN – set of communication standards for optical fibers that carry voice, digital & video signals across phone lines.  Cable Modem Cable connected using coaxial cables or wiring, which are the same cables that you use to get cable TV. modem Servers and a system that provides resources, data, services, or programs to other computers, known as clients, servers over a network. In theory, whenever computers share resources with client machines, they are considered servers.  Architecture Refers to overall physical structure, peripherals, interconnections within the computer & its system software especially the operating system. Can be divided into five fundamental components: ü Input/output ü Storage ü Communication ü Control ü Processing  Architecture Two types of network architecture: Broadcast – done by transmitting the same information to all computers in the network – typically used in LANs Point-to-point – the computer for w/c information is intended is identified first, & the communication is only to that particular computer. – typically used in “dial-up” networking  Topology Defines how the network components in a LAN are interconnected within a physical area & describes their physical interconnection. Different topology: – Bus – all the node computers are directly attached to a line. – Star – centralized structure where all computers are connected through a central computer called the server.  Topology Ring – all LAN computers were connected in a ring fashion with wires or cables that directly connected all the computers together. Forms: – Hub – consists of a “backbone” or main circuit, attached to a number of outgoing lines – Arcnet – uses a “token bus” system managing line sharing among all the users on the network. Computer software and systems  Software OS Software The OS is the most important software on any computer. It is the very first program to load on computer start-up and is fundamental for the operation of all other software and the computer hardware. Is theExamples general term applied to the instructions of commonly used OSs include the Microsoft Windows family, Linux, and Mac OS X.OS Software that direct theThe computer’s OS is the mosthardware to perform important software on any work. computer. It is the very first program to load on computer start-up and is fundamental for the operation Its consist of allof instructions other software and thecommunicated computer hardware. electronically Examples of commonly used OSs include the Microsoft to the hardware. Windows family, Linux, and Mac OS X.  Types of software: System Software Boots up the computer system; controls input, output and storage; and controls the operations of the application software; Consist of programs that controls the operation of the computer and its devices. OS Software is the most important software on any computer. It is the very first program to load on computer start-up and is fundamental for the operation of all other software and the computer hardware. Examples of commonly used OSs include the Microsoft Windows family, Linux, and Mac OS X.  Types of Software: Operating System A computer cannot function without an operating system. A set of programs containing instructions that coordinate all the activities among computer hardware resources. Some examples of operating systems include Apple macOS, Microsoft W indows, G oogle's Android OS, Linux Operating System, and Apple iOS. System Software vs Operating System  Types of software: Application Software Includes the various programs that users require to perform day-to- day tasks.  Application Software Types of Application Software – Word processor – Spreadsheet – DBMS (Database Management System) – Graphics – Educational – Games – Accounting Package  Productivity Software- such as an office suite, is the type of software most commonly used both in the workplace and on personal computers. Several software companies produce this type of multiple-program software, which usually bundles together word processing, spreadsheet, database, & presentation. Creative software- includes programs that allow users to draw, paint, render, record music and sound, and incorporate digital video and other multimedia. Communication Software- Networking and communication software enable users to dialogue, share, and network with other users via the exchange of email or instant message (IM), by accessing the World Wide Web.  Utilities / Utility Program Software that performs specific task, usually related to managing your computer, its devices, or its programs.  User Interface Is a part of the software with which you interact; it controls how data and instructions are entered and how information is presented on the screen. Types of User Interface – Command Line Interface – Graphical User Interface (GUI)  Types of user Interface: Command Line Interface You type keywords or press special keys from the keyboard to enter data and instructions. – Command language – set of commands you use to interact with the computer. Types of User Interface: Graphical User Interface Allows you to use menus and visual images such as icons. – Icons are small images that represents a program, instructions or information.  Language Translation Utilities Translation programs are needed to convert instructions written in English-like language into binary. These translation programs are called assemblers, compilers or interpreters.  Programming Language Is a means of communicating with the computer. Is a set of words, symbols, and codes that enables a programmer to communicate a solution algorithm to computer. Generations and level of programming language: The term “level” refers to how close the language is to the actual machine. First level includes the first two Machine language and assembly generations of programming language: language Second level includes high-level procedural and nonprocedural language Third level (fifth generation) is natural language.  Machine Language Is the true language of the computer. Its consists only of binary numbers 1’s and 0’s, representing the on and off electrical impulses. – Byte consists of 8 bits. – For example no.3 has an 8 bits of 00000011  Assembler Language Its far more English- like language. Assemble language instructions have a one-to-one correspondence with a machine language instructions. Sample Code: PRINT_LOOP: CALL WRITE_CHAR INC DL LOOP PRINT_LOOP MOV AH,4CH INT 21H;21H Third Generation Language Procedural language – requires the programmer to specify both what the computer is to do and the procedure on how to do it.  Fourth Generation Language Specialized application programs that require more involvement of the user in directing the program to do necessary work. FIFTH GENERATION LANGUAGE Are also called natural language. The user tells the machine what to do in the user’s own natural language or through use of a set of very English-like commands.  Software Packages Is designed to meet the needs of a wide variety of users, not just a single user or company. Is sometimes called commercial-off-the- shelf software.  Software Useful to Nurses: – Admission, Discharge and Transfer (ADT) systems – Medication Administration Record (MAR) software – Charting Software – Computerized Acuity System – Hospital Email System – Chat rooms – Electronic Bulletin Boards – Listservs  Admission, discharge and transfer (ADT) systems Medication administration record (MAR) software - ensures that each healthcare provider has the necessary information to administer medications confidently and safely, maintaining consistency and accuracy in treatment. (Drug Interactions,Missed Doses,Administration Errors) Charting software  Listserv - a two-way communication tool that allows for discussion and collaboration among members. OTHERS: Electronic Health Record (EHR) Software: EHR software is one of the most popular type of software used by hospitals and clinics. EHR software collects information on patients – for example, the medication they take, doctors’ recommendations, and the procedures that they have undergone in the past. Many programs also include a financial module for invoicing and payment, and a separate portal for the patient, which allows patients to access their consultation history, medical records, and prescriptions. The two most popular types of EHR software are: Electronic patient record software (EPR) – used internally by hospitals to store and process their patient information. Electronic medical record software (EMR) – used to store data like medication types and dosage, past and planned procedures, and data on the patient’s recovery course. Medical database software: Similarly to Electronic Health Record software, medical database software stores patients’ histories and treatment plans. However, unlike in EHRs, the database is categorized by disease, not patients’ profiles. Medical database software helps healthcare professionals in two key areas: Making better treatment decisions by cross-referencing a patient’s case with similar cases. Educating themselves by reviewing clinical cases of a given disease. A dermatologist can use this type of software to browse all patients diagnosed with Atopic Dermatitis and compare their symptoms, treatments, and recovery plans. Medical research software: Medical research software is used for two primary purposes: education and sharing research with the medical community. This type of software is commonly used to train medical personnel and to support diagnosis if no similar clinical cases among patients can be referenced internally. Medical diagnosis software: Medical diagnosis software for doctors allows them to exchange anonymized patient records so that they can fill any informational gaps preventing them from providing an accurate diagnosis. This type of software often leverages artificial intelligence (AI) to analyze all available patient data and generate probable diagnoses. Medical imaging software: Medical imaging and visualization software is used primarily for processing MRI/CT/PET scans and designing 3D models. E-prescribing software: More and more countries around the world are switching to electronic prescriptions, which also means e-prescribing software is becoming a must-have for doctors. The software lets medical professionals track, renew, and cancel prescriptions for their patients. It’s also integrated with national drug reference databases. Telemedicine software: Telemedicine software lets healthcare professionals carry out appointments with patients online, either via a web browser or a mobile app. In some software, the video conferencing feature is complemented by e-prescriptions and a billing module. Appointment scheduling software: Booking software helps hospitals, clinics, and medical practices manage their appointment systems online. Typically, the software features a patient panel that lets individuals schedule appointments via an app or website. An Overview Data and Data Processing What is Data? According to Mullins (2013), data is “a fact represented as an item or event out of context”, which simply means that a data in isolation lacks meaning or relevance until it is contextualized. An example is number 39. Without context, such as knowing whether this temperature is from a weather report, a scientific experiment, or a fever measurement, it provides limited insight. Data - raw uninterrupted Reordered and labeled as U s i n g t h e When the nurse uses facts that are without vital signs they have nurse’s knowledge this knowledge to make meaning meaning and now information is then appropriate decisions represent information interpreted. The nurse fits and acts on those these data into a pattern of prior knowledge about vital decisions the nurse signs. exhibits wisdom. E.g. the following series of temperature 98.0, pulse 58, E.g. if the nurse records these In other words, the nurse numbers are dat a, wit h no respirations 18, and blood vital signs as part of a physical demonstrates wisdom when meaning: 98, 116, 58, 68, 18. pressure116/68 for a high school athlete, they the nurse synthesizes and are in the normal range; appropriately uses a variety of however, if these same knowledge types within nursing numbers were part of an actions to meet human needs. assessment on an elderly patient with congestive heart failure, the low pulse and blood pressure could suggest a problem.  The Nelson Data to Wisdom Continuum. Revised Data Information Knowledge Wisdom (DIKW) Model-2013 Version The DIKW framework is a conceptual model used to describe the progression from raw data to actionable knowledge and wisdom. It’s often depicted as a pyramid with four levels: Data, Information, Knowledge, and Wisdom. This framework is widely used in fields like information science, data m a n a g e m e n t , a n d organizational learning. Data, information, knowledge, and wisdom are central to effective healthcare delivery. Nurses are skilled in managing and communicating information and are always concerned with content quality. Nursing informatics is also concerned with the creation, structure, storage, delivery, exchange, interoperability, and reuse of nursing and clinical information along the continuum of care. The DIKW model indicates that, as one moves from data to information to knowledge to wisdom, there is increasing complexity (shown as the X-axis) and increasing interactions and relationships (shown as the Y-axis). Information systems are shown at the intersection of data and information, decision support systems are depicted at the intersection of information and knowledge and expert systems, the most complex of the systems, reside at the intersection of knowledge and wisdom. Which simply means that, the development of informatics tools to support nursing practice will continue to evolve as we develop more and better understanding of these complex relationships. DATA STATES: Data alone do not provide insights. As noted, without context it is difficult to make judgments on data alone. It is because of this that data are presented here as a collection of data processes for the storage, curation, retrieval, and interpretation of data with the end goal being to gain wisdom. Therefore, when discussing digital data, it is important to discuss the three states of data— data at rest, data in motion, and data in use (Rouse & Fitzgibbons, 2019). 1. DATA AT REST This is archived data that rarely change. These data are subject to security protocols to protect the confidential nature of these data. Refer to data on storage devices such as a removable one such as a USB thumb drive, a hard drive, a file server, a cloud severs, or offsite backup servers. EXAMPLE: Patient’s past medical records data 2. DATA IN USE Refer to data that the information system is currently updating, accessing, reading, or processing. This is its most vulnerable state as it becomes open to access or change by others. Some of these data may contain sensitive data-like social security numbers, birth dates, health insurance numbers, results of diagnostic tests, and so forth. One can attempt to secure these data in use through passwords and user IDs, but these are only as secure as the person’s ability to keep that information private, and the nature of the encryption technology used. 3. DATA IN MOTION Data moving between applications, between locations within a computer system (RAM to hard drive, files are moved or copied from one folder to another) , over the network, or over the Internet. Data in motion are an increasing concern in healthcare because streaming data are now available from sensors, monitoring devices, mobile devices, and so forth. It is important that one encrypts these data before moving and while moving to these devices. While data in motion entail security risks, they also provide opportunities that we imagined. EXAMPLE: Monitoring patients in real time in their homes can lead to improved patient care and compliance DATA SOURCES: Data may be obtained from multiple sources, this includes: 1. CLINICAL DATA Vital Signs Lab Results Diagnosis and Treatment Records Progress notes 2. ADMINISTRATIVE DATA Billing System Scheduling Systems Admission and Discharge 3. PATIENT-GENERATED DATA Health apps Fitness trackers Patient Reported Outcomes The advent of computer technology powerful enough to store and analyze data has changed the way that we gather, curate, analyze, and present data in order to make the best decisions about patient health. TYPES OF DATA: Two primary approaches in classifying data in a database system 1. classified in terms of how these data will be used by the user financial data, patient data or human resource data 2. classified by their computerized data type data can be numbers or letters or combination of both CONCEPTUAL TYPES OF DATA Conceptual Type of Data is based on the source of data and it reflects how users view data. Moreover, it is based on the event that the data are attempting to capture. For example, image data from x-ray, lab data, assessment data, intervention data and outcome data. COMPUTER-BASED DATA a) Alphanumeric Data: –includes letters & numbers in any combination EXAMPLE: address, social security number b) Numeric data: used to perform numeric functions format options –the number of digits after the decimal or the presence of commas in a number it can be long integer, currency, scientific date & time are special types of numeric data Data Assessment: What is data assessment in nursing informatics? Data assessment involves taking inventory of all data handled, classifying it based on confidentiality, and periodically reassessing classifications and access privileges. Electronic patient-reported outcomes assessment allows patients to provide structured health information to inform their care. Nursing informatics improves safety by utilizing technology to facilitate the collection, analysis and reporting of higher-quality data related to patient safety issues and health outcomes, as well as to prevent medical errors and allow for better monitoring and reporting of those that do occur. Definition: The systematic collection, organization, and analysis of data to inform decision-making in patient care. Components of Data Assessment: Data Collection: Sources: Electronic Health Records (EHR), wearable devices, patient portals. Methods: Manual input (e.g., nurse-entered data) and automated collection (e.g., sensor data). Data Validation: Ensures accuracy, reliability, and completeness of patient data. Tools: Data scrubbing software, clinical guidelines for charting. Data Interpretation: Translating raw data into actionable insights. Example: Identifying early signs of sepsis through vital sign trends. Role in Decision Support: Early detection of complications through predictive analytics. Guiding personalized care plans based on historical and real-time data. Challenges: Data overload. Ensuring interoperability between different systems. Personal, Professional, and Educational Informatics: Personal information in nursing informatics pertains to individual patient data collected during care. This information includes demographic data (name, age, gender, and address), medical history, allergies, and current medications. With the rise of digital health records, managing personal data effectively has become a core responsibility. Importance of Managing Personal Information: 1.Privacy and Confidentiality – Ensuring patient data privacy is governed by standards such as the Health Insurance Portability and Accountability Act (HIPAA). Breaches in confidentiality can lead to legal consequences and loss of patient trust. 2.Accuracy and Security – Accurate personal data is vital for proper diagnosis and treatment. Utilizing secure electronic health record (EHR) systems reduces risks of data breaches, improves care coordination, and supports data sharing between departments. 3.Patient-Centered Care – Personal information allows healthcare professionals to personalize treatment plans, ensuring the care provided aligns with each patient's unique needs. Professional Informatics: Use of informatics in clinical practice to support professional roles. Health informatics (HI) professionals are tasked with important responsibilities of obtaining, storing, organizing, management and utilizing data for the purpose of improving the services provided by the healthcare industry especially for the patient care. Professional information refers to the knowledge, documentation, and data related to healthcare providers. This includes nurses' credentials, roles, and clinical performance data. Role of Professional Information: 1.Credentialing and Licensure – Maintaining accurate records of nurses' certifications, licensures, and professional development is critical for compliance with regulatory and accreditation bodies. 2.Performance Monitoring – Data on nurses' competencies, adherence to best practices, and patient outcomes supports quality improvement and identifies areas for additional training. 3.Workforce Management – Informatics systems help track staffing levels, nurse-to-patient ratios, and scheduling, optimizing resource allocation and preventing burnout. Examples: EHR systems for patient documentation. Clinical decision support systems (CDSS) to improve care accuracy. Shift scheduling and communication apps for team collaboration. Educational Informatics: Definition: Application of informatics to enhance learning and professional development. Importance of Educational Informatics: Accessibility to Knowledge – Online resources reduce barriers to education and provide up- to-date content on medical advancements. Critical Thinking Development – Case studies and decision-making tools foster analytical skills that are vital in dynamic clinical settings. Examples: Online learning platforms for continuous education. Simulation technologies for hands-on training in a virtual environment. Digital libraries and research tools for accessing the latest evidence-based practices. Managing personal, professional, and educational information effectively in nursing informatics enhances patient safety, supports professional growth, and advances nursing education. Understanding these elements equips future nurses to adapt to evolving healthcare technologies and improve care outcomes. Emphasizing informatics literacy prepares nurses to navigate data- rich environments, optimize workflows, and participate in interprofessional collaboration to deliver high-quality care. Skills Needed in Nursing Informatics: 1. CLINICAL EXPERIENCE AND COMPETENCE 2. CRITICAL THINKING, ANALYSIS, AND PROBLEM-SOLVING 3. TECHNICAL/COMPUTER SKILLS 4. BUSINESS CORRESPONDENCE SKILLS 5. INTERPERSONAL SKILLS 6. PROJECT MANAGEMENT SKILLS ICT and Nursing Education Education is a critical component of many nurses informatics functions and may directly affect the success and failure of any new or modified IT solution. Responsibilities Educators and trainers assess and evaluate informatics skills and competencies while providing feedback to the learner regarding the effectiveness of the activity and the learner’s ability to demonstrate newly acquired skills. Informatics Nurse Innovators define and develop educational technologies, integrate the solutions into the educational and practice environments and challenge organizations to consider and adopt innovative informatics solutions. Information and Technology Systems: A Dependable System for Quality Care Applications of Nursing Informatics in the different facets of Nursing Practice: The nursing process of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation can be enhanced through the utilization of technology. Technology, when properly developed and applied, has been shown to enhance the healthcare team’s ability to collect, categorize, interpret, manage, evaluate, and share relevant information. This also enhances the team’s ability to manage client care in a more efficient and productive manner. In most cases, the utilization of technology has decreased the nurse’s workload associated with collecting and categorizing data, while enabling and enhancing the sharing of relevant information with other members of the healthcare team. Core Systems Supporting Nursing Practice Electronic Health Records (EHRs): Centralized, real-time access to patient information. Enhances communication among healthcare teams. Clinical Decision Support Systems (CDSS): Provides alerts, reminders, and evidence-based recommendations. Examples: Alerts for drug interactions or fall risk assessments. Patient Portals: Facilitates patient engagement in their own care. It is a secure website that allows a patient to access their healthcare information using the internet. Improves communication between nurses and patients. Telehealth and Remote Monitoring Systems: Enables care delivery for patients in remote or underserved areas. Examples: Telemonitoring devices for chronic diseases. Barcoding and Medication Administration Systems: Reduces medication errors. Ensures compliance with the "five rights" of medication administration. Characteristics of a Dependable System: Interoperability: Seamless integration of data from various systems. User-Friendliness: Intuitive interfaces for ease of use by nurses. Data Security: Protecting patient information with encryption and access controls. Ensuring compliance with regulations like HIPAA. Scalability: Adaptable to growing healthcare demands and technological advancements. Benefits of Dependable Systems: Improved Patient Outcomes: Real-time data for accurate and timely interventions. Enhanced Nurse Efficiency: Automation reduces administrative burdens. Data-Driven Decision-Making: Evidence-based practice supported by robust data analytics. Challenges: High costs of implementation. Resistance to change among staff. Technical issues leading to downtime. EXAMPLES OF INFORMATION SYSTEMS: Clinical Information System (CIS) Comprehensive and integrative system that manages the administrative, financial, and clinical aspects of a clinical facility; a CIS should help to link financial and clinical outcomes. An example is the EHR. Decision Support System (DSS) Organizes and analyzes information to help decision makers formulate decisions when they are unsure of their decision’s possible outcomes. After gathering relevant and useful information, develops “what if” models to analyze the options or choices and alternatives. Expert Support Systems: Expert systems are computer programs that can mimic human reasoning and solve complex problems in a specific domain. They use a knowledge base of facts and rules, and an inference engine that applies logic and reasoning to draw conclusions. Represents the present and future vanguard of nursing informatics. These systems aim to help make the nurse “more intelligent” in providing quality care based on evidence. Uses artificial intelligence (AI) to model the decisions an expert nurse would make. Provide the “best decision” recommendations based on what an expert nurse would do unlike decision support systems that provide several options from which nurse selects.  Advantages of expert systems Provide a solution more quickly than Reduce waste and cut costs humans Improve patient care by sharing the knowledge and wisdom of human experts Expert systems four main components: Natural Knowledge Inference Database language base Engine Used to Contains Facts Links the interface and rules for specific to knowledge interact with decision- the domain base rules the end user making focus, i.e., with the nursing database Executive Support System Collects, organizes, analyzes, and summarizes vital information to help executives or senior management with strategic decision making. Management Information Systems (MIS) Provides summaries of internal sources of information, such as information from the transaction processing system, and develops a series of routine reports for decision making. Hospital Information System (HIS) Manages the administrative, financial, and clinical aspects of a hospital enterprise. It should help to link financial and clinical outcomes. Clinical, Critical, and Hospital Perspective: Applications in Clinical, Critical, and Hospital Perspectives Electronic Health Records (EHRs): Centralized documentation of patient information for real-time access by clinicians. Promotes continuity of care and reduces medical errors. Facilitates clinical decision-making through decision support systems (DSS). Telehealth in Acute Care: Remote patient monitoring for critical conditions. Virtual consultations between specialists. Smart Beds and Wearables: Monitoring vital signs in critical care settings. Automated alarms for changes in patient status. Smart beds with built-in sensors help keep patients safe. The beds weigh patients and record the weights in the patients' electronic health record. The beds can also sense movement when someone is trying to get up. This alerts the nurses nearby, who can check on patients who might be at risk of falling. Medication Management Systems: Integration of barcoding technology to reduce medication errors. Ensures accurate medication administration in critical and hospital care. Analytics for Quality Improvement: Tools to track outcomes, identify trends, and implement process improvements. *The use of ultrasound guidance to facilitate PIV insertion in patients with difficult access decreases the number of attempts required and improves success rates. * An intrathecal pump, also known as a pain pump, is a surgically implanted device that delivers medication directly to the fluid surrounding the spinal cord. Bar Coded Medication Administration (BCMA) Barcoded Medication Administration (BCMA) is an inventory control system that uses barcodes to prevent human errors in the distribution of prescription medications at hospitals. The goal of BCMA is to make sure that patients are receiving the correct medications at the correct time by electronically validating and documenting medications. The information encoded in barcodes allows for the comparison of the medication being administered with what was ordered for the patient. This software was designed to improve medication administration accuracy and to generate online patient medication records. Barcode technology reduced dispensing errors up to 96% and documentation errors by 80.3%. A BCMA system consists of a barcode printer, a barcode reader, a mobile computer (with Wi-Fi), a computer server and software. Each drug in the hospital is labeled with a unique barcode. When a patient is prescribed medication, it is faxed, sent electronically or hand delivered to the hospital's pharmacy and entered into a computer system by a pharmacist. The pharmacist dispenses the barcoded dose of the drug to the patient's floor. When it's time for the clinician to administer the medication, he uses a handheld device to scan the barcodes on his identification badge, the patient's wristband and the drug. If the barcode point-of-care (BPOC) system cannot match the drug to be given with the order in the system, it alerts the clinician with a visual warning. Each patient's barcode holds all the vital information about the patient and his medication. * The BPOC system is designed to make sure that the right drug is given to the right patient via the right route in the right amount and at the right time. This information is referred to as the "Five Rights." *This is an assistive device that allows patients in hospitals and nursing homes and people receiving home health care to be transferred between a bed and a chair or other similar resting places, by the use of electrical or hydraulic power. eXeX Ai provides theatre practitioners with a real-time view of upcoming surgical steps. This eliminates the need to constantly anticipate the surgeon's next move, allowing scrub practitioners to proactively prepare instruments. The technology also simplifies room setup by displaying the required equipment layout, ensuring efficient utilisation of space and resources. Benefits for surgical teams: Improved workflow efficiency through real- time surgical step visualisation. Enhanced preparedness for scrub practitioners, minimising delays during procedures. Optimised room setup with clear equipment layout instructions. Extracting real-time analytics to enhance accuracy, efficiency, and perpetually improve each procedure. Community and Public Health: Population Health Management: Use of big data analytics to monitor and respond to community health trends. Identifying at-risk populations for targeted interventions. Health Education Platforms: Mobile apps and online portals for health promotion and disease prevention. Empowering individuals with health literacy. Remote Monitoring and Mobile Health (mHealth): Mobile apps for chronic disease management, e.g., diabetes and hypertension. Community workers equipped with tools for real-time data entry and care coordination. Immunization Tracking Systems: Ensuring compliance and timely administration of vaccines. Reducing outbreaks through centralized records. Ambulatory Care Systems: Applications in Ambulatory Care Systems Streamlined Scheduling and Workflow Automation: Systems for patient scheduling, reducing wait times, and optimizing clinic efficiency. Integrated Patient Portals: Enabling patients to access their health records, lab results, and follow-up care plans. Telemedicine Services: Virtual consultations for routine check-ups and follow-up visits. Reduces barriers to access for patients in remote areas. Care Coordination Across Facilities: Linking ambulatory care providers with hospitals, specialists, & laboratories. Ensuring seamless transitions in care. Emergency Preparedness and Risk Response: Disaster Management Tools: Real-time data sharing for coordinated responses during natural disasters, pandemics, or emergencies. Examples: Surveillance systems for early detection of disease outbreaks. Simulation and Training: Virtual reality tools for training nurses in emergency protocols. Enhancing preparedness for mass casualty events. Emergency Communication Systems: Automated messaging platforms to alert healthcare teams and the public. Electronic Triage Systems: Prioritizing patients based on severity during emergencies using decision support. Incident Command Systems (ICS): Streamlining roles and responsibilities during a health crisis. Ensuring effective resource allocation and situational awareness. Telehealth: An approach to unified and accessible health care for all Types of Telehealth Services: Synchronous Services: Real-time communication between providers and patients (e.g., video consultations). Asynchronous Services: Storing and forwarding health information for later review (e.g., lab results or imaging). Remote Patient Monitoring (RPM): Continuous monitoring of health metrics like blood pressure, glucose, or oxygen saturation using wearable devices. Mobile Health (mHealth): Health apps and mobile devices for patient self-management and education. Key Technologies: Video conferencing tools for virtual consultations. Mobile apps for chronic disease management. Wearable devices for remote health tracking. Secure messaging systems for provider-patient communication. Telehealth’s Role in Unified and Accessible Healthcare: Bridging Geographical Gaps Provides care to underserved areas such as rural and remote locations. Reduces travel burdens for patients and families. Enables access to specialists through virtual consultations. Addressing Health Disparities Supports equitable access to care for marginalized populations. Language translation features in telehealth platforms for diverse communities. Affordable care options through reduced transportation and facility costs. Continuity of Care Integration of telehealth data with Electronic Health Records (EHRs). Ensures smooth transitions between primary, specialty, and emergency care. Empowers patients through continuous engagement and follow-ups. Benefits of Telehealth: For Patients: Convenience: Access care from home or work. Cost Savings: Reduced expenses for travel and missed workdays. Improved Engagement: Real-time updates and communication enhance understanding and adherence to care plans. For Providers: Efficiency: Optimized workflows and reduced no-show rates. Expanded Reach: Ability to serve patients in distant areas. Data Insights: Continuous health monitoring provides actionable insights for personalized care. For Healthcare Systems: Reduced Hospitalizations: Early detection and management of health issues. Scalable Solutions: Ability to handle large patient populations. Crisis Management: Effective during pandemics or disasters. Challenges in Telehealth Implementation: Technological Barriers: Lack of high-speed internet in rural areas. Digital literacy gaps among patients and providers. Regulatory and Privacy Concerns: Compliance with laws like HIPAA for secure data sharing. Variations in licensing and reimbursement policies across regions. Clinical Limitations: Difficulty conducting physical exams remotely. Limited ability to address emergencies or acute issues. Case Studies and Applications: Case Study 1: Chronic Disease Management Patient with diabetes uses RPM for blood glucose monitoring. Benefits: Early detection of fluctuations, real-time adjustments to care. Case Study 2: Rural Maternal Care Pregnant woman in a remote area accesses prenatal care through video consultations. Outcome: Reduced complications and improved maternal-fetal health. Telehealth as a Unifier: Breaks barriers of geography, resources, and accessibility to deliver quality healthcare. Nursing’s Role: Nurses are vital in implementing, educating, and optimizing telehealth systems to improve patient outcomes. Nurses must embrace telehealth as a tool for advocacy, care delivery, and equity. General Workplace Technology and Administrative Applications: Workplace technologies and administrative applications in nursing informatics are crucial for improving efficiency, patient outcomes, and operational workflows. Goal: Improve the health of patients by optimizing information management and communication within healthcare systems. General Workplace Technology in Nursing: Electronic Health Records (EHRs) Purpose: Centralized storage of patient data for real-time access and sharing. Features: Documentation of patient history, medications, and test results. Integration with clinical decision support systems (CDSS). Benefits: Enhances data accuracy and accessibility. Reduces redundancy and errors. Communication Tools Secure Messaging Apps: Facilitate HIPAA-compliant communication among healthcare teams. Telehealth Platforms: Enable remote monitoring and consultations. Mobile Devices and Apps: Access to clinical guidelines, drug databases, and real-time patient updates. Barcode Medication Administration (BCMA) Use: Reduces medication errors by scanning patient and medication barcodes. Integration: Linked to EHRs for accurate documentation. Point-of-Care Technology Examples: Handheld devices, tablets, and portable diagnostic equipment. Purpose: Streamlines bedside care by providing immediate access to patient data. Wearable Devices and IoT Monitor patient vitals remotely, such as heart rate, oxygen saturation, and glucose levels. Data flows directly into EHRs or analytics platforms for trend analysis. Administrative Applications in Nursing Informatics: Scheduling and Staffing Tools Automated systems for creating optimal nurse schedules. Monitors real-time staffing needs and adjusts to patient acuity levels. Workflow Management Systems Track and allocate resources efficiently. Provide dashboards to visualize task progress and priority levels. Patient Portals Offer patients access to their records, appointment scheduling, and communication with providers. Enhance patient engagement and reduce administrative workload. Data Analytics and Reporting Tools: Tableau, Power BI, or integrated EHR analytics modules. Monitor performance indicators like readmission rates and infection control metrics. Generate compliance and regulatory reports (e.g., for Joint Commission audits). Inventory Management Systems Ensure timely availability of medical supplies. Use RFID and barcode technology to track inventory levels. Financial and Billing Systems Automate coding, billing, and insurance claims. Reduce administrative errors and improve revenue cycle management. Challenges and Ethical Considerations: Data Security and Privacy Ensure compliance with laws like HIPAA and GDPR. Implement secure access controls and encryption. Interoperability Issues Integrating disparate systems to ensure seamless data exchange. Adopting standards like HL7 and FHIR. Technology Usability Need for intuitive interfaces to minimize learning curves. Involvement of nurses in system design to ensure alignment with clinical workflows. Change Management Training and support for staff to adapt to new systems. Addressing resistance through stakeholder engagement. Emerging Trends in Nursing Informatics: Artificial Intelligence (AI) and Machine Learning: Predictive analytics for patient outcomes. Virtual Reality (VR) Training: Simulated environments for nursing education. Blockchain: Enhancing data security and interoperability. Robotics: Assisting in patient care and administrative tasks.