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Computers, Informatics, Clinical Information, and the Professional Nurse Nursing Information Systems Background: • Evolution of technology “technology explosion” nursing informatics to include the application of: – Computers – Technology – Nursing science to the management and processing of nursing data, information and knowledge Purpose of Nursing Informatics • Micro-level: Study the process and structure of nursing information to support clinical decisionmaking and the delivery of nursing care. – In Jordan, electronic patient files are not yet created for nursing and medical care purposes they exist only for the purposes of accounting and billing mostly in the private sector ( المستشفى األستشاريwill be a paperless hospital) • Macro-level: Helps in retrieving evidence-based standards of practice, legislation acts, statistical analysis of the profession of nursing and practitioners of nursing in Jordan at any given time or interval of time. Issues Raised by the Emergence of Nursing Informatics in Jordan 1. Preparation of nursing students in: • • Computer skills Electronic information management systems 2. Ethics and confidentiality of patients’ records 3. How do we maintain consistent quality standards of “caring” across Jordan? The Role of the Jordanian Nursing Council (JNC) in Monitoring Nursing Information Systems and Informatics in Jordan 1. May 2002 Royal Decree approving constitution of the JNC 2. July 2002 HRH Princess Mona El Hussein appointed President of the JNC 3. Nine Task forces are currently working for the purpose of developing the nursing profession in Jordan by regulating its practice and developing scientific knowledge and practical skills in nursing The Role of the Jordanian Nursing Council (JNC) in Monitoring Nursing Information Systems (Continued) 4. A large data base is being mounted to: – Study the situation and the status of nursing to include all education levels and service sectors – Study current and future requirements for nurses and midwives – Nursing specialties, standards of nursing practice and competence in each specialty – Job descriptions and nursing ethics with case studies and situation analysis 5. Well-articulated and coordinated nursing information systems are needed to inform these taskforces based on national and international databases Issues Raised at the Macro-level by the Emergence of Nursing Informatics in Jordan 1. How will these databases be used to advocate effectively for legislation reform and to gain the support of the government for the nursing profession? 2. How will the private sector be included in the process to gain national consensus? 3. How will these databases and identified needs from them be used to implement change at the education, practice and research levels in nursing in Jordan? Knowledge Management and Nursing Informatics Frameworks Leveraging intellectual assets Sharing knowledge & best practices Instilling responsibilities for knowledge sharing Capturing & reusing past experiences Understanding & measuring the value of knowledge Building & mining Customer knowledge bases Producing knowledge as a product Mapping networks of experts Driving knowledge generation for innovation Source: Xerox Company Application of Knowledge Initiatives in Nursing 1. Nursing Informatics is now taught in certain university programs at the graduate level in USA Program Outcomes are: 2. – – – – – Prepare leaders in the specialty Develop technologies that support clinical decision-making Facilitation and support of data collection, entry and retrieval in collaboration with other health care disciplines creation of an integrated clinical information system Integrating standardized nursing languages into clinical information systems Application of Knowledge Initiatives in Nursing (continued) 1. 2. 3. Best practices “very trendy” and completely a participatory process of knowledge sharing and measurement to get evidence-base for professional standards Global networks of nursing experts such as the International Network for Doctoral Education (INDEN) are mapped electronically as well as networks of research the Nursing Informatics Workgroup ( a part of the International Medical Informatics Association (IMIA-NI) Building knowledge customer base is done by Clientcentered Informatics a trend in health care and Nursing Informatics in particular Transformation of Data to Knowledge Used by permission of J.R.Graves and S. Corcoran “The Study of Nursing Informatics” Image: Journal of Nursing Scholarship 21 (4): 227-231, 1989 Knowledge Information Data Four Main Concepts Identified in Nursing Informatics 1. Data (objective information) 2. Information (data + interpretation + organisation + structure) 3. Knowledge (information + synthesis) and relationships identified and formalised Nursing Informatics Map Nursing Informatics: What? Multidisciplinary, scientific endeavor of modeling: • How nurses manage and collect data • Process data into information and knowledge • Make knowledge-based decisions and inferences for patient care • Using empirical and experiential knowledge to broaden scope and enhance the quality of professional practice • A combination of computer science, information science and nursing science Nursing Informatics: How? 1. Using discourse about motives for computerised systems 2. Analysing, formalising, and modeling nursing information processing in: • Clinical practice • Management • Education • Research 3. Investigating • Determinants • Conditions • Elements • Models and processes to test effectiveness and efficiency of computerised information, telecommunications and network systems for nursing practice and their effects on nursing practice Nursing Informatics: Values and Beliefs The nursing information system supports a professional practice model (Data input for advancing science of nursing, best in research (evidence- based best practices) . Data belong to the patient (integrates with other applications as part of the electronic patient record continuity of health care documentation across the life span. The nursing information system uses standardized language (pre-defined data elements: structured data base ALL health care members improve communication improve quality management and nursing research WITHIN and ACROSS health care settings . The nursing information system provides decision support: guide care planning and documentation Nursing Informatics: Values and Beliefs (continued) 5. 6. 7. The nursing information system reflects standards of care • Hospitals • Nursing professional associations • Regulatory agencies • Departmental policy and procedure committee The nursing information system supports professional nursing judgment: • A rich database of patient care order groups assures that the nurse can individualize the patient's care. • Each order group contains patient care orders that can be modified to meet individual needs. Users are involved in every aspect of the nursing information system: • Design, development, implementation, and evaluation. • Nurses from all areas of practice participate in our informatics committees and groups. Applications Of Nursing Informatics USA and Jordan 1. 2. 3. Point of care computers placed on the nursing units provide access to patient electronic records to nurses and other health care providers resulting in: – Error-free orders – Capturing drug and food allergies – Documentation of medications – Capturing nursing care measures electronically – Paperless diagnostic results from x-ray and laboratory departments and physical and respiratory therapy departments. Worldwide web is used by nurses for: – Informing themselves of current research – Industry updates – Experiences and publications in health care and nursing Consumers are informed about: – Aspects of “wellness” and “quality of life” – Elements of health care Applications Of Nursing Informatics USA and Jordan 4. 5. USA: first two graduate programs in Nursing Informatics at the University of Maryland and the University of Utah in 1988 and 1990 respectively Jordan: None of the nine faculties of nursing provides Nursing Informatics either at the graduate or undergraduate levels. – Private universities: Al Zaytoonah considering to offer a course at the fourth year undergraduate level as an elective stream parallel to community health nursing – Continuing professional education: will be considered with the JNC – The issue of unavailability of faculty tot each this subject and the alternative is to recruit non-Jordanian faculty and send Jordanian faculty for preparation in the USA Nursing Roles in Informatics: USA 1. Nurses to be included in the design and application of systems of Software used in Nursing Informatics 2. Nurses are processors of information as they manage and communicate data in a variety of settings 3. Career opportunities, employment in: – Acute ambulatory settings – Academia – Computer applications companies – Consulting firms Nursing Roles in Informatics: USA 4. Evidence-based practice has led to the fact that all nurses need to be computer and information – management literate 5. At the entry level nursing role (post BSN) a nurse must be able to: – Use a word processor, communicate by email, use bibliography from the Internet – Respect copyright laws and netiquette and respecting confidentiality of patients files. – Human-computer interaction ergonomics become instrumental for nurses to know – Tele-health technologies used by the nurses in the USA for rural areas and prisons Nursing Roles in Informatics: Jordan In Jordan roles are less developed than USA however all faculties have included basic and advanced computer skills courses as a requirement from MOHE for accreditation Some of the faculties (JUST, Hashemite University and Al Zaytoonah Private University of Jordan) have started elearning initiatives and on-line courses Some of the teaching hospitals are planning to become paperless for e.g. King Abdullah the Founder teaching hospital At the service levels acute ambulatory settings and some of the private and teaching hospitals have computer applications and point-of-care computers to a varying degree: electronic files are used for billing, pharmacy, disposable and medical supplies items as well as dietary and hospitality services. A paper less hospital opening very soon JNC is planning a computer-based JNCE for all baccalaureate graduates effective next year Jordanian Nursing Council for Nurses and Midwives currently retrieving a national database of nursing and midwifery practitioners in Jordan. Conclusion: Ethical and Quality Concerns with Nursing Informatics 1. 2. 3. 4. Confidentiality – Standards for confidentiality must be set in place during automation and be monitored by a Quality Assurance or Ethics Committee or even Risk Management Committee Data entry quality: systems to monitor of complete and accurate data entry must be set in place to maintain data integrity otherwise speeding up communication and dissemination of errors in data. Fragmentation of nursing tasks: How to match standards of care with advances in technology? Answer lies in having nurses involved with system design explore workflow processes because automated information system development is NOT a duplication of the paper system. It involves an IMPROVEMENT in the processes in place by using technology The integration and assimilation of technology into the everyday life of health managers and health professionals will inevitably become an increasing reality. • • • • • • • • • • • • • • Introduction………………………………………………….. 4 Systems for Admission, Discharge, Transfer…………. 5 Order Communication Systems………………………….. 7 Test Result Reporting………………………………………. 9 External Access to Multisource Data……………………. 11 Electronic Methods of Access and the Master Patient. 13 Central Scheduling Systems……………………………….. 16 Improvements in the Patient Care: Telehealth……….. 20 Telnursing………………………………………………………. 22 Telemedicine…………………………………………………… 23 Telepresence ………………………………………………….. 23 Telepractice ……………………………………………………. 24 Robots in surgery ………………………………………… 25-28 Conclusion …………………………………………………….. 29 Information technology refers to a system utilized to retrieve, manage, process, and disseminate information by means of telecommunication. •Telecommunication is the transmission of information from one site to another. •Use of equipment to transmit information in the form of signs, signals, words, or pictures by cable, radio or other systems. SYSTEMS FOR ADMISSION, DISCHARGE, TRANSFER •A patient’s entry into health care always involves registration at the providing facility. •Registration information is needed by all care providers. •It was this need that supported the development of registration systems as one of the first information systems (Iss) to be used in health care. Systems for Admission, Discharge, Transfer •Information collected through registration should be electronically transmitted to all user who need the data. •Electronic transmittal assures that uniform data exist at all locations. •Also, electronic transmittal decreases the risk of errors associated with duplicate data. •Registration system assigns a unique identifier to all patients, which has been called the medical record number. •To access patient records at different sites of care, users must have a way to link all medical record numbers within an enterprise to obtain a longitudinal record of care received by the patient. Order Communication Systems •Order communication systems automate the processing of clinical orders to the providing departments. •Traditionally, order entry systems have been transcription based, which allow for clerical entry of physician order from paper charts. •Support of clinical order entry through use of graphical user interface (GUI) orders. •GUI uses pull-down menus, dialog boxes, pictures or icons, file folders, and other on-screen aids to allow user to navigate the system operations. •GUI orders allow users to easily enter new orders or modify existing orders at any time, from any system function, during patient record review. Orders Communication Systems •When the order management system sends an order to an automated ancillary system, the order is electronically placed directly into the ancillary system, without intervention of department staff. •Orders transmitted to ancillary departments that are not automated are usually sent via message to the department printer. •The most commonly automated ancillary systems are laboratory, radiology, and pharmacy. Test Result Reporting •After tests are reported by the service department, the results should be made accessible to all system users. •To facilitate review, results should be presented in results display and results storage. •Results display: Test results are accessible for on screen display. •The list is usually presented in reverse chronological order. •Results storage: Results are stored in the system’s database. •Two ways of access to results; by direct access into the source system or by query into the source system. Test Results Reporting *Ancillary and clinical system results can also be stored in a clinical data repository. *Use of a common data repository for all clinical systems allows users to access information from one location. *Also eliminates or decreases duplication of data entry, and usually enhances performance. External Access to Multisourced Data •External access is generally less efficient. •Often, institutions that have very effective internal IS s lack effective linkages to patient data at other sites of care. •Hospital based caregivers can usually access results from any automated hospital based system. •Older Methods of Access: clinicians have compensated for a lack of access to patient information by phoning for the data and writing it down External Access to Multisourced Data *This method is less than desirable because it is time consuming and holds considerable potential for errors. *With the proliferation of fax, which provide clinicians with paper copies of patient data from alternate sites of care, access to information has improved. *However, faxes still present a problem, in that access requires that the site be open when the information is needed. *When caregivers cannot access data, they must determine if test results can wait or if repeat testing is needed. Electronic Methods of Access and the Master Patient Index *The real value of collecting data electronically is assuring access to all users at the time of need. *Access to records should be available regardless of the location of the user or the record. *Preferred solutions for access to multisourced data include the use of: Data repositories: Which store data from multiple systems and allow users, based on security clearance, to access the data. Electronic Methods of Access and the Master Patient Index Data repositories:Which store data form multiple systems and allow users, based on security clearance, to access the data. Networks: Which link computers with link computers within the same general physical area, and wide area networks which create links over large geographic areas. Community health information networks: Which are clinical messaging networks that provide patient data form multiple sites across defined geographic areas. Master patient indexes (MPIs): Which is a cross-referencing mechanism for identification and access of patient data from multiple sources. *It supports health care organizations with multiple and changing sources of patient identification and registration. Electronic Methods of Access and the Master Patient Index *Common objectives for MPI include: a) Providing a fast, reliable, thorough, enterprise wide patient search capability. b) Assisting in the prevention of duplicate patient entries in a network. c) Detecting duplicate patient entries and providing facilities for review and correction of these exceptions. d) Accepting registration, case, and member input from multiple sources. e) Cross-referencing entries form multiple data sources. data. f) Storing patient demographics, insurance, and other g) Providing a source for network wide unique patient identifiers. Central Scheduling Systems •It was developed to facilitate patient scheduling through one or more department within an institutions or an enterprise. •Central scheduling departments schedule both inpatients and outpatients for exams, tests, and other procedures. •Central scheduling systems give institutions a distinct competitive edge in the marketplace. •Also place an increasingly important role in patient satisfaction outcomes. •Central schedulers have access to identified department patient schedules and coordinate scheduling of patient test. •At the same time, schedulers assure that exams are appropriately sequenced. •In addition, that patients are expedited through multiple departments and/or facilities in the shortest time possible. Central Scheduling Systems •Patient have one stop scheduling and are assured that test are appropriately sequenced. •Central scheduling department staff assures that patients receive appropriate instructions required for test. •Some unique issues of a central scheduling systems include: Departmental ownership and control of schedules: Scheduling departments frequently believe that only the servicing department can appropriately schedule patients. Central Scheduling Systems Staffing concerns: When scheduling staff are centralized, participating departments need to contribute to the full-time equivalent component of the new centralized scheduling department. The goal of computerized patient records is to use automation to provide users concurrent data analysis, and appropriate warnings and alerts. Fully functional automated systems improve patient care, clinical outcomes, and caregiver productivity. Information is one of the most valuable resources in health care. Appropriate management of information as a resource will maximize the usability, quality, and value of information. To the extent that we are able to collect, store, and retrieve clinical information within institutions, across organized sites of care, and across nonaligned sites of care, we will be able to improve the delivery of care, clinical outcomes, and operations within and beyond the enterprise. Improvements in the Patient care • TELEHEALTH: Telehealth is the utilization telecommunications technology to link two or more enduser sites by any interactive electronic means, such as telephone, computers, e-mail, fax, and interactive video transmissions for the purpose of transfer and/or exchange of information and data in any health-related application. • It is remote, electronic, clinical consultation, assessment, and monitoring of consumers of any form of health care. • Telehealth has now become an integral component in the delivery of health care, regardless of geographic or socioeconomic status. Telehealth continuation • A variety of related services and resources including the following: *Retrieval and transmission of medical records and data. *Consultation, assessment, and management of medical record and data. *Identification and diagnosis of new illnesses. *Implementation and management of a medical regimen of treatment for those illnesses. *Patient and caregiver education and support. TELENURSING: Telenursing is the subset of telehealth that utilizes telecommunications and nursing informatics to support the practice of nursing and the provision of professional nursing care to patients on remote residential or clinical settings. It is a amalgam nursing informatics, nursing science, and the art of nursing. The focus of the most recent activity, however, has been on telenursing applications that primarily employ advanced image and audio capabilities. These technologies can range from high-resolution still images (e.g., Xrays) to sophisticated interactive teleconferencing systems and networked computers. Telenursing is the synchronicity of nursing science and nursing informatics. TELEMEDICINE: Telemedicine is the transfer of medical information from one distant site to another utilizing electronic communications for the purpose of illness prevention, health maintenance, provision and monitoring of patient care, education of patients and their health maintenance, provision and monitoring of patient and their health care providers, and support of health care practitioners from other disciplines. It is remote electronic medical diagnosis, consultation, and treatment that can take place either synchronously (in real time) or asynchronously. TELEPRESENCE: This is the newest concept in telemedicine. It encompasses the use of advanced technology such as virtual reality for relatively Sophisticated medical procedures such as surgery, in which robotics and virtual reality are integrated to manipulate instruments and perform selected surgical procedures on patients at remote, often inaccessible sites. TELEPRACTICE: Telepractice may refer to any professional providing interactive, long-distance consultant services to his or her client.. The provider fo the service might be a nurse. In its broadest applications, telepractice can utilize e-mail, telephone, fax, or any form of Internet communication. Robots in Surgery We always hear in the news almost every day of some kind of technology or scientific advance. One of the topics more interesting that are surrounding us right now is the robotics technology. The machines might be permitted to make all of their own decisions without human oversight, or else human control over the machines might be retained. Some of the robots that we have right now are the following: ROBOTS THAT OPERATE IN BRAINS: This robot is called “Pathfinder” and it will provide surgeons with a way of guiding instruments very precisely to the chosen site of the brain with minimal damage to surrounding tissue. Potential uses included the treatment of brain tumors • The robot carries a camera that automatically matches the scanner image to the position of the patient's head on the operating table. ROBOTS TO PERFORM HEART SURGERY: It performs heart bypass surgery using robotic devices in the delicate procedures. The aim of this robot was to create a safer less invasive means of performing heart surgeries. The robot has the ability to hold the camera and tools perfectly that leads to eliminates errors caused by even slight tremors of the surgeon’s hands. • ROBOTS IN LAPAROSCOPIC INGUINAL HERNIA REPAIR: This robot know as AESOP a fiber optic camera smaller than a pencil is threaded in to the abdomen that is held by the robot. This robot responds to oral directions. The robot might not recognize the voice, if the surgeon's tone that day is different from the recording. • ROBOTS IN TELESURGEERY: Using surgical robots and computers, experienced physicians can conduct surgery anywhere in the world. Surgical robots augment a surgeon's ability by scaling down range of motion, providing three-dimensional vision and eliminating hand tremor. Since laparoscopic surgery is performed with only a minimal incision, the patient e Robots are expected to make surgery safer and cheaper, and recovery much faster. But mostly the idea is to do surgery with the smallest incision possible. CONCLUSION As we can see technology is and it is going to be the world revolution of any time. Since scientists, engineers and all kind of people will look for better ways of make life easier and safer. And the only way to achieve this is with the help of Technology. This science is growing rapidly and is offering us great advantages to our life. Like is in the Hospital Industry. We could see that technology is very important in here because, one of the most important things for the humanity is our HEALTH, that is why this industry has to be updated in order to offer new discoveries to help people to survive and always be healthy. We can see that we don’t have the same utensils as before, now we are updated and we have the newest and biggest technology in medicine. This made us think about the big help that the world needs from us. As a CIS student we can contribute with anything to the world industry.