Download 12. Computers, informatics, clinical information, and the professional

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.