ENHANCING%20CLINICAL%20CARE%20THROUGH%20NURSING%20INFORMATICS

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ENHANCING CLINICAL CARE THROUGH NURSING
INFORMATICS
DECEMBER 14, 2009
2
QUOTE OF THE DAY

• "Computers are incredibly fast, accurate and
  stupid. Human beings are incredibly slow,
  inaccurate and brilliant. Together they are
  powerful beyond imagination."
• - Albert Einstein

3
DO YOU KNOW WHAT A TOILET BOWL CAN DO?

• can redden faces
• can measure sugar levels in urine
• can measure blood pressure, heartbeat, body fat
  and weight
• can do nearly everything

4
REDDEN FACE?
An American diplomat was at a dinner party in a
Japanese home when he excused himself to go to
the bathroom. He did his business, stood up and
realized he didn't have a clue about how to flush
the toilet.
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REDDEN FACE?
The diplomat speaks Japanese, but he was still
baffled by the colorful array of buttons on the
complicated keypad on the toilet. So he just
started pushing. He hit the noisemaker button
that makes a flushing sound to mask any noise you
might be making.
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REDDEN FACE?
He hit the button that starts the blowdryer for
your bottom. Then he hit the bidet button and
watched helplessly as a little plastic arm, sort
of a squirt gun shaped like a toothbrush,
appeared from the back of the bowl and began
shooting a stream of warm water across the room
and onto the mirror.
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REDDEN FACE?
And that's how one of America's promising young
Foreign Service officers ended up frantically
wiping down a Japanese bathroom with a wad of
toilet paper. "It was one of my most
embarrassing experiences in Japan," said the
embassy employee who asked not to be identified.
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NEOREST 600
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NEOREST 600
The Neorest 600 from Japanese plumbing
manufacturer Toto is a tankless toilet and
personal cleansing unit. Its lid automatically
opens when a person approaches it. When a person
walks away from the Neorest 600, it automatically
flushes and closes the seat and lid. There's a
remote control for operating features including
water spray temperature, pressure and direction
seat heater air dryer and deodorizer. List
prices for the Neorest 600 start at US5,200.
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FRIENDLY RESTROOM
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FRIENDLY RESTROOM
Built-in assistance The Friendly Rest Room
combines a slew of high-tech features including a
contactless smart card to store users'
preferences, voice activation interface, and
sensor systems for detecting falls and emergency
situations. Users can control settings including
seat height and tilt with a remote control or
voice-activated commands. Researchers affiliated
with Vienna University of Technology in Austria
conceived the Friendly Rest Room as a way to
provide greater independence to elderly and
disabled people who might otherwise rely on
assistance from a caregiver to use a toilet.
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INTELLIGENT TOILET
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INTELLIGENT TOILET
Japanese homebuilder Daiwa House Industry
collaborated with Toto to design the Intelligent
Toilet, which doubles as an in-home health
monitor. The design includes devices for
measuring sugar levels in urine, blood pressure,
body fat and weight.
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WHO AMONG US ARE LIKE THIS FELLOW?
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ARE YOU FRIENDLY OR TOXIC TO COMPUTERS?
Let Computers Help You, Not Break You!
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HOW?

• BY IMPROVING YOUR COMPUTER LITERACY

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COMPUTER LITERACY

• Computer literacy is commonly used today to
  denote some kind of basic knowledge and an
  understanding of computers combined with the
  ability to use them effectively.

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COMPUTER LITERACY

• On the least specialized level, computer literacy
  involves knowing how to turn on a computer, start
  and stop simple application programs, and save
  and print information. It also refers to the
  attitude about computers and the actual ability
  to do some tasks or programs on the computer.

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COMPUTER LITERACY

• The relationship between computer literacy,
  technological competence and a nurse's ability to
  care is congruent for quality care. Computer
  literacy represents a proactive response to
  technology which enhances caring in nursing
  (Delaney, 1990).

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COMPUTER LITERACY

• AM I COMPUTER LITERATE?

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HOW FAR DO YOU KNOW?

• ANIA
• BCMA
• CI
• CPOE
• CPU
• CPRS

• EHR
• EMR
• HIS
• PC
• PDA
• RAM

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HOW FAR DO YOU KNOW?

• ANIA - American Nursing Informatics Association
• BCMA - Bar Code Medical Administration
• CI - Clinical Informatics/Informaticist
• CPOE - Computerized Physician Order Entry
• CPRS - Computerized Patient Record System
• EHR - Electronic Health Record
• EMR - Electronic Medical Record
• HIS - Hospital Information System
• PDA - Personal Digital Assistant

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TOP BUSINESS ISSUES IMPACTING HEALTHCARE

1. Increasing Patient Safety/Reducing Medical Errors
2. Patient (Customer) Satisfaction
3. Nursing Shortage

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CURRENT IT PRIORITIES

1. Reduce Medical Errors/Promote Patient Safety
2. Implement an EMR
3. Connecting IT at Hospital and Remote Locations

Source Healthcare Information and Management
Systems Society (HIMSS)
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CHALLENGES FOR NURSING

• Fragmented, frequently interrupted, in chaotic
  work environment
• Interrupted mid-activity 8 times per every 8
  hours
• Switch patients every 11 minutes
• Average activity time 3.1 min/care activity
• Average of 8.1 operational failures per 8 hours
• Missing med
• Missing supplies
• Missing order
• Missing/ broken equipment

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CHALLENGES FOR NURSING

• 9 of time spent on resolving system failures or
  errors
• Most common was missing medications
• Direct patient care tasks done in 243 minutes
  chunks
• Average 44 minutes overtime
• Only 30 of shift time is in direct patient
  care
• Medication administration errors
• in 1999, ADE cost the U.S. 2 billion annually

Sources Tucker and Spear. Operational
Failures and Interruptions in Hospital Nursing.
HSR 41643-662, 2006 Hendrich A., George V.
Random work sampling of Medical Surgical nurses
using PDAs. Reported at Health Management
Academy, May 20, 2004. Unpublished Data
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CHALLENGES FOR CLINICIANS

• We practice with incomplete information
• We have alarming error rates
• We spend 30-50 of time on administrative
  activities
• Errors are associated with surveillance, change
  in venues, and patient handoffs
• Fragmented, incomplete records can cause
  confusion, communication breakdown, and the
  opportunity for error.
• We need to reduce burdens related to documentation

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LEARNING OBJECTIVES

• Define nursing informatics
• Demonstrate how NI supports nursing process
• Explain the value of NI to nursing practice and
  healthcare
• Identify roles for NI practice
• Identify practice areas and settings
• Identify education paths and certifications

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THE IMPORTANCE OF INFORMATION

• The healthcare of your clients is largely
  dependant on information.
• Every action taken depends on previous
  information and knowledge.
• The delivery of health care requires information
  about
• Science of type of care (nursing)
• Patient or client
• Provider
• Outcomes
• Process and systems for delivery of care

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THE IMPORTANCE OF INFORMATION

• Information about each of these areas have an
  impact on the type and the amount of care given.
• Information must be
• accurate
• timely
• accessible
• understandable

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WHAT IS INFORMATION?

• The structure of information
• Delivered in conversation, handwritten notes,
  stored in a computer.
• Regardless of the form, the same basic principles
  apply to the structure and the use of
  information.
• Words are often used interchangeably to describe
  information.

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WHAT IS INFORMATION?

• The structure of information
• Data discrete entities objectively described,
  without interpretation or context.
• Example 110
• Information data processed into a structured
  form. Data that are interpreted, organized,
  structured and given meaning are referred to as
  information.
• Example When combining 110 with other data, it
  becomes information. Systolic blood pressure of
  110 mmHg and diastolic blood pressure of 70 mm
  Hg. This information can be captured in a form,
  on a graph in a report.

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WHAT IS INFORMATION?

• Knowledge synthesized information derived from
  the interpretation of data. It provides a logical
  basis for making decisions.Essential to
  decision-making and to new discoveries.
• Example When the blood pressure reading is
  combined with information about anatomy and
  physiology, pharmacology, pathophysiology,
  knowledge is used to decide about further care
  and treatment.

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THE FIVE RIGHTS OF INFORMATION

• Information has five rights
• Right information
• Right person
• Right time
• Right place
• Right amount

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USING INFORMATION

• Up-to-date, accurate information of each step
  of the Nursing Process is the Power behind safe,
  high quality patient-centered care!

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USING INFORMATION

• Evidence-based practice leads to
• Determining standards and guidelines
• Guide for decision-making process
• Determines best practice
• Nursing informatics can enable dissemination of
  new knowledge.
• Practitioners update themselves of new
  developments through journals, conferences,
  continuing education sessions.
• The information is varied and copious.
• There is a need to find the relevant evidence in
  a timely way.

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WHAT IS HEALTHCARE INFORMATICS?

• With the knowledge of the importance of
  information in healthcare, healthcare informatics
  has become a specialty.
• Healthcare informatics is a combination of
  computer science, healthcare science, information
  science and cognitive science.

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WHAT IS HEALTHCARE INFORMATICS?

• Computer science development, configuration,
  architecture of computer hardware and software.
• Healthcare science body of knowledge on which
  healthcare profession bases their practice. The
  sciences of anatomy, physiology and knowledge
  specific to each profession.
• Information science also includes information
  technology which involves the process of sending
  and receiving information.
• Cognitive science the process of human thinking,
  understanding and remembering.

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HOW FAR HAVE WE COME?

• 1992 First Scope of Practice for Informatics
  Nurse
• 1992 Informatics Nursing recognized as a
  specialty by ANA
• 1994 First Informatics Nursing Certification
  exam offered by ANCC
• 2007 3rd Version of Informatics Nursing Scope
  of Practice
• 2007 AONE identifies Information Management and
  Technology as a core competency for Nurse
  Executives

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WHAT IS NURSING INFORMATICS (NI)?

• Nursing Informatics is a specialty that
  integrates nursing science, computer science, and
  information science to manage and communicate
  data, information, and knowledge in nursing
  practice.  Nursing informatics facilitates the
  integration of data, information, knowledge, and
  wisdom to support patients, nurses and other
  providers in their decision-making in all roles
  and settings.  This support is accomplished
  through the use of information structures,
  information processes, and information
  technology. 
•  (ANA Scope Standards of Nursing Informatics
  Practice, 2008)

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WHAT IS NURSING INFORMATICS (NI)?

• Like any knowledge-intensive field these days,
  nursing is greatly impacted by the explosive
  growth of computer technology. Nursing
  informatics is a new and exciting specialty that
  combines nursing skills with computer expertise.
  Nurse informatics specialists manage and
  communicate nursing data and information to
  improve decision making by consumers, patients,
  nurses and other health care providers.

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SCOPE STANDARDS OF PRACTICE

• System Lifecycle
• Human Factors
• Information Technology
• Information Management
• Professional Practice
• Models and Theories

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IN vs. INS

• IN Informatics Nurse
• RN who works in the area of informatics
• This RN is not formally prepared in informatics
  but has an interest and/or experience working in
  the area.
• INS Informatics Nurse Specialist
• RN with advanced, graduate education in nursing
  informatics or information management

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NURSING INFORMATICS JOB TITLES

• 14 clinical analysts
• 14 informatics nurse specialist or nursing
  informatics specialist
• 9 consultant
• 40 identified other
• Director of Clinical Informatics, Clinical
  Informatics Coordinator, Clinical Systems
  Analyst, Clinical Informatics Specialist

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NI SPECIALIST SALARY

• In 2007, the Healthcare Information and
  Management Systems Society (HIMSS) conducted a
  major survey of nurse informatics specialists.
  The average salary earned by respondents to this
  survey was 83,675, compared to 69,500 in the
  2004 survey. This is strong evidence of the
  increasing maturity and value of the specialty.

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NURSE INFORMATICS CAREER OUTLOOK

• The demand for all types of nurses is expected to
  increase significantly over the next ten years.
  In general, the more training, certifications and
  experience a nurse has, the more demand there
  will be for his or her skill set.

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HEALTHCARE INFORMATION AND MANAGEMENT SYSTEMS
SOCIETY (HIMSS) LEVEL 7
STAGE CUMMULATIVE CAPABILITIES OF HOSPITALS
7 Medical record fully electronic care delivery organization able to contribute to electronic health record as byproduct of electronic medical record 0.0
6 Physician documentation, full clinical decision support system (variance and compliance), full PACS 0.1
5 Closed-loop medication administration 0.5
4 CPOE, clinical decision support system (clinical protocols) 1.9
3 Nursing documentation, eMAR , clinical decision support system (error checking), PACS 8.1
2 Clinical data repository, controlled medical vocabulary, clinical decision support interface engine, document imaging 49.7
1 Ancillaries laboratory, radiology, pharmacy 20.5
0 All three ancillaries not installed 19.3
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WHY IT IS IMPORTANT?

• Nurses need to develop competencies in
  informatics.
• Informatics enables nurses to use information
  and communications technologies in the
• collection of data,
• use of information
• generation of knowledge to support nursing
  practice

Technology
Nursing
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WHY IT IS IMPORTANT?

• the trend in hospitals are computerizing nursing
  documentations
• for effective and efficient data management such
  as workload statistics, performance monitoring,
  etc.
• promotes and improves evidence-based nursing
  practice and patient outcomes.

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WHY IT IS IMPORTANT?

• Nursing informatics enables nurses to quickly
  move to the synthesis of nursing knowledge and
  the development of nursing wisdom. Gone were the
  days of manual documentation that consumes most
  of your time, now, more time are used in applying
  nursing knowledge and wisdom to everyday care
  because of informatics.

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WHY IT IS IMPORTANT?

• NURSING INFORMATION SYSTEMS (NIS) includes
• Patient Charting
• Staff Schedules
• Clinical Data Integration
• Decision Support

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WHY IT IS IMPORTANT?

• Patient Charting A patients vital signs,
  admission and nursing assessments, care plan and
  nursing notes can be entered into the system
  either as structured or free text. These are the
  stored in a central repository and retrieved when
  needed.
• Staff Schedules Nurse can self schedule their
  shifts using scheduling rules provided in shift
  modules. The shifts can later be confirmed or
  changed by a scheduling coordinator or manager.
  Shift modules are designed to handle absences,
  overtime, staffing levels and cost-effective
  staffing.

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WHY IT IS IMPORTANT?

• Clinical Data Integration Here clinical
  information from all the disciplines can be
  retrieved, viewed and analyzed by nursing staff
  and then integrated into a patients care plan.
• Decision Support Decision support module can be
  added to NIS , and they provide prompts and
  reminders, along with guides to disease linkages
  between signs/symptoms, etiologies/related
  factors and patient populations. Online access to
  medical resources can also be made available.

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ROLE OF THE NURSE INFORMATICIST

• Nurse programmers who write or modify computer
  programs for use by nurses
• Nurse communicators who work with other nurses to
  identify computer system needs or to assist in
  the training and implementation of those systems
• Informatics nurse managers who manage or
  administer information systems
• Nurse vendor representatives who demonstrates
  systems to potential customers

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WHAT CAN AN INFORMATICS NURSE DO?

• Support nursing work processes using technology
• Design systems to match clinical workflows
• Telehealth
• Homehealth
• Ambulatory care
• Long-term care
• Acute care all specialties
• Outpatient settings
• Software development

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WHAT CAN AN INFORMATICS NURSE DO?

• Increase the accuracy and completeness of nursing
  documentation
• Improve the nurses workflow
• Eliminate redundant documentation
• Automate the collection and reuse of nursing data
• Facilitate analysis of clinical data

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WHAT CAN AN INFORMATICS NURSE DO?

• Admitting a patient
• Admission Assessment in computer
• Placing orders
• Requesting consults
• Sending data to NIS/HIS
• Resolving clinical reminders
• These things involve a computer as well
• Take V/S
• Give medications
• Consent for surgery
• Make the bed

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WHAT CAN AN INFORMATICS NURSE DO?

• Prepare/provide workload statistics
• How many new orders written on Ward X in a day?
• How many medications given on Ward X in a week?
• Nurses bypassing BCMA by using Manual Medication
  Entry
• Show me all restraint orders for the past month

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WHAT CAN AN INFORMATICS NURSE DO?

• Information system management
• Documenting patient education
• Incorporated into daily charting
• Training/educating
• New employees
• Student nurses

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COMPETENCIES REQUIRED

• Most theorists also emphasize the need for every
  nurse whether employed in the practice or
  education setting, to develop a minimum of a
  "user" level in computer literacy and informatics
  theory.

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TECHNICAL COMPETENCIES

• Related to the actual psychomotor use of
  computers and other technological equipment.
  Specific nursing informatics competencies include
  the ability to use selected applications in a
  comfortable and knowledgeable way. It is
  important that nurses feel confident in their use
  of computers and software in the practice
  setting, especially at the bedside, in order to
  be able to attend to the client at the same time.

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LEVEL OF COMPETENCIES

• beginner, entry or user level
• intermediate or modifier level and
• advanced or innovator level of competency.

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COMPUTER APPLICATIONS

• All three levels of competencies - users,
  modifiers and innovators need to develop a
  working knowledge of the following computer
  programs and processes
• Word processing
• Keyboarding
• Spreadsheets
• Presentation Graphics

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COMPUTER APPLICATIONS

• Databases (simple to complex)
• Desktop Publishing
• World Wide Web
• E-mail programs
• Expert data systems
• Multimedia
• Telecommunication devices
• Nursing information systems
• Hospital information systems
• Peripherals (Printers, CD/DVD)

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USER LEVEL TECHNICAL COMPETENCIES INCLUDE

• uses word processing applications
• demonstrates keyboarding skills
• uses spreadsheet applications
• uses telecommunication devices to communicate
  with other systems
• uses e-mail systems to communicate with other
  health care professionals
• uses presentation applications to create slides,
  displays, overheads(PowerPoint, Corel
  Presentation, etc.)
• uses multimedia presentations

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USER LEVEL TECHNICAL COMPETENCIES INCLUDE

• uses internet resources to locate client support
  groups, online resources
• uses sources of data that relate to nursing
  practice and care
• accesses, enters and retrieves data related to
  client care via available hospital or nursing
  information systems
• uses database management programs to develop and
  access databases and tables
• uses database applications to enter and retrieve
  data and information

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USER LEVEL TECHNICAL COMPETENCIES INCLUDE

• conducts online and database literature searches
• uses decision support systems, expert systems and
  other aids for clinical decision making and care
  planning
• uses computer applications to document client
  care
• uses computer applications to plan client care,
  including discharge planning
• uses computer applications to enter client data
  (demographic, V/S, physiological data)

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USER LEVEL TECHNICAL COMPETENCIES INCLUDE

• uses information management systems for client
  education
• uses technology based client monitoring systems
• operates peripheral devices (bedside and hand
  held)
• uses operating systems
• uses computer peripheral devices (CD ROMs, DVD,
  zip drives)
• uses computer technology safely

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USER LEVEL TECHNICAL COMPETENCIES INCLUDE

• navigates in Windows environment effectively
• demonstrates basic technology skills (load paper,
  change toner, unjam printers, print)

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MODIFIER LEVEL TECHNICAL COMPETENCIES INCLUDE

• applies technology support to provide evidenced
  based practice
• synthesizes data from more than one source and
  applies to practice
• demonstrates awareness of and ability to access
  data and information from multiple sources
• uses decision support systems in practice

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MODIFIER LEVEL TECHNICAL COMPETENCIES INCLUDE

• accesses pertinent literature resources and
  incorporates into practice and professional
  development
• creates and accesses research and other documents
  electronically

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INNOVATOR LEVEL TECHNICAL COMPETENCIES INCLUDE

• participates in the design and development of
  information systems for nursing practice
• develops inventive ways to access data and
  interact with information systems
• participates in the design and develop design and
  development of new applications for nursing
  practice
• participates in developing new methods for data
  and information organization

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INNOVATOR LEVEL TECHNICAL COMPETENCIES INCLUDE

• collaborates with information technology
  consultants and other members of information
  system development team
• collaborates, negotiates with and directs
  information technology vendors
• proficiency in diverse computer application
  programs
• manipulates and enhances nursing data sets
• organizes and directs applications of shared data
  sets

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INNOVATOR LEVEL TECHNICAL COMPETENCIES INCLUDE

• develops data gathering tools and processes for
  literature search access for nurses
• develop charting and documentation templates for
  use in nursing practice
• design and development of evidenced based
  practice documentation and processing within
  practice area

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CERTFICATION AND EDUCATION

• AMERICAN NURSES CREDENTIALING CENTER (ANCC)
• Informatics Nurse (23)
• is the official certifying organization for
  informatics nurses. The prerequisites for
  certification include a baccalaureate or higher
  degree in nursing or a baccalaureate degree in a
  relevant field, an active registered nurse (RN)
  license in the United States, and 2 years of RN
  practice plus 2,000 hours of informatics nursing
  practice within the previous 5 years or 12 hours
  of academic credit in a graduate program in
  nursing informatics and 1,000 hours of nursing
  informatics practice within the previous 5 years.

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CERTFICATION AND EDUCATION

• HEALTHCARE INFORMATION MANAGEMENT SYSTEMS
  SOCIETY (HIMSS)
• Certified Professional in Healthcare Information
  and Management Systems (CPHIMS 3)
• OTHER 9
• NONE 55

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SUMMARY

• Informatics can make nursing practice visible in
  local, national, and international health care
  data sets, thus empowering nurses with
  information to influence policy.
• Information is a critical component of effective
  decision-making and high quality nursing
  practice.  The information and knowledge gained
  through nursing informatics can bring increased
  awareness and understanding of nursing and health
  care issues.

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SUMMARY

• Nursing Informatics is committed to maintaining a
  clinical perspective and promoting research that
  would bear directly on improving patient care.
• Recognition of Nursing Informatics team value in
  support of clinical excellence is crucial to any
  healthcare organizations success.

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FRIENDLY ADVICE

• Work towards achieving the INNOVATOR LEVEL of
  technical competency
• Keep abreast of latest greatest technology
  trends
• Assess newest technology for fit and potential
  applicability in your nursing profession

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NURSING INFORMATICS ORGANIZATIONS

• A short list of examples includes
• American Nursing Informatics Association (ANIA)
• Australian Nursing Informatics Council (ANIC)
• Brazilian Nursing Association Nursing Informatics
  Group
• British Computer Society Nursing Specialist Group
• European Nursing Informatics (ENI)
• International Medical Informatics Association
  Nursing Informatics Special Interest Group
  (IMIA-NI)
• NURSINFO Hong Kong
• Spanish Society of Nursing Informatics and
  Internet (SEEI)
• Swiss Special Interest Group Nursing Informatics
  (SIG-NI)

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CONCLUSION

• Computers cannot replace a nurse, they cannot
  replace your intuition, and they cannot replace
  your intelligence and certainly not your TLC.
  Nurses cannot become robots, doing only what the
  computer tells them to do.

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QUOTE OF THE DAY

• "Computers are incredibly fast, accurate and
  stupid. Human beings are incredibly slow,
  inaccurate and brilliant. Together they are
  powerful beyond imagination."
• - Albert Einstein

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REFERENCES

• http//nursing-informatics.com
• http//ojni.org
• http//www.ania.org/
• http//www.himss.org
• http//www.cna-nurses.ca