Introduction to Nursing Informatics
Computers have become a part of everyday life for many individuals, including nurses. Computers are
used for educating nursing students and clients; assessing, documenting, and testing clients’ health
conditions; managing medical records; communicating among healthcare providers and with clients; and
conducting nursing research.
All nurses must have a basic level of computer literacy (the knowledge and ability to use computers or
technology) in order to perform their jobs.
General Concepts
Informatics refers to the science of computer information systems. It is a Quality and Safety Education in
Nursing (QSEN) competency defined as “use information and technology to communicate, manage
knowledge, mitigate error, and support decision-making” (Cronenwett et al., 2007). Health informatics,
or health information technology, then, is the management of healthcare information, using computers.
Nursing informatics is the science of using computer information systems in the practice of nursing. It is
defined by the American Nurses
Association (ANA, 2014) as “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 . . . [to support] nurses, consumers, patients, the interprofessional
healthcare team, and other stakeholders in their decision-making in all roles and settings to achieve
desired outcomes”.
The first nursing information systems conference was held in the United States in 1977. Nurses have
taken significant strides since then to design and adapt computer processes to enhance client care,
education, administration and management, and nursing research. Advanced practice in nursing
informatics is a growing specialty. The first ANA certification examination in nursing informatics was
given in October 1995. Nursing informaticists or nursing informatics specialists are currently in much
demand.
Job descriptions for these practitioners often include the important roles of interfacing between the
client care and information technology departments and assisting with the development,
implementation, and evaluation of initiatives in clinical information systems.
The use of computers to systematically solve problems is referred to as information technology (IT). In
nursing, the Technology Informatics Guiding Education Reform (TIGER) Initiative began in 2006 to
identify information and knowledge management best practices and effective technology capabilities for
nurses. TIGER is focused on clinician education through the integration of IT, information literacy,
informatics and technologies, developing and implementing learning innovations, and increasing1faculty
and student acceptance and understanding of health IT through education and training, incentives, and
supports (Healthcare Information and Management Systems Society, 2019).
The terminology used to describe the parts and functions of computer technology can be confusing.
New terms emerge daily and it is a challenge to keep up with them2
Acronym Meaning
CAI: Computer-assisted instruction
CPOE: Computerized provider (or physician) order entry
CPR: Computer-based patient record
EHR: Electronic health record
HIS: Hospital information system
LAN; WAN: Local-area network; wide-area network
MB; GB; TB: Megabyte; gigabyte; terabyte
MIS: Management information system
PDA: Personal digital assistant
PHI: Protected health information
PHR: Personal health record
URL: Universal resource locator (web address)
VPN: Virtual private network2
Computer Systems
A computer system—not in the sense of one machine but of a network of computers, users, programs,
and procedures in an organization—assists the healthcare team with decision making and
communication. The two most common types of computer systems used by nurses are management
information systems and hospital information systems.2
Management Information Systems
A management information system (MIS) is designed to facilitate the structure and application of data
used to manage an organization or department. The system provides analyses used for strategic
planning, decision making, and evaluation of management activities. All levels of management benefit
from the ability to access accumulated data.
Hospital Information Systems
A hospital information system (HIS) is an MIS that focuses on the types of data needed to manage client
care activities and healthcare organizations. As with any system, the goal is to provide individuals with
the data they need to determine appropriate actions and control them. Typically, an HIS will have
subsystems in the areas of admissions, medical records, clinical laboratory, pharmacy, order entry, and
finance. The personnel in these areas record the data needed to allow management of billing, quality
improvement, scheduling, and inventory both within their own areas and across the institution. 3
Technology in Nursing Education3
Computers enhance academics for both students and faculty in at least four ways. These include access
to literature, computer-assisted instruction, classroom technologies, and strategies for learning at a
distance.3
Technology in Nursing Practice3
Many activities of the registered nurse involve collecting, recording, and using data. Computers are well
suited to assist the nurse in these functions. Specifically, the nurse records client information in
computer records, accesses other departments’ information from centralized computers, uses
computers to manage client scheduling, and uses programs for unique applications such as home health
nursing and case management. Improvement in both clinical and nonclinical processes can occur
through technology in biomedical monitoring, communication, client safety systems, decision support,
and education. As a component of accreditation of schools of nursing as well as health organizations,
nurses are expected to have knowledge about the benefits and limitations of technology, skills in using
technology for communication and decision 3
Computer-Based Client Records
Electronic health records (EHRs) or computer-based patient records (CPRs) permit electronic client data
entry and retrieval by caregivers, administrators, accreditors, and other individuals who require the
data. An EHR can improve healthcare in at least four ways:
(1) constant availability of client health information across the lifespan,
(2) ability to monitor quality,
(3) access to warehoused (stored) data, and
(4) ability for clients to share in knowledge and activities influencing their own health.3
Because of the way computers provide access to EHRs, providers can easily retrieve specific data such as
trends in vital signs, immunization records, and current problems. The system can be designed to warn
providers about conflicting medications or client parameters that indicate dangerous
conditions.Sophisticated systems allow replay of audio, graphic, or video data for comparison with
current status. Challenges with reading handwriting are eliminated and all text is searchable.
There are several areas of concern with EHRs. Maintaining the privacy and security of data is a
significant4issue. One way in which computers can protect data is by user authentication via passwords
or biometric identifiers (e.g., fingerprint, palm vein, or retinal scans)—only those
individuals who have a legitimate need to access the data receive the password. Additional policies and
procedures for protecting the confidentiality of EHRs are evolving as the use of computer records
becomes more widespread.
One role of the nurse informaticist, an expert who combines computer, information, and nursing
sciences, is to develop policies and procedures that promote effective and secure use of computerized
records by nurses and other healthcare professionals.
Clinical Decision Support Systems
For many years, nurses have used charts, templates, algorithms, and other tools to assist in reaching
decisions regarding client care. Clinical decision support systems are electronic forms of these tools,
which incorporate evidence from the literature into particular client situations in order to guide care
planning. In particular, with these systems, characteristics of individual clients are used to generate
client-specific assessments or recommendations that are then presented to clinicians for consideration.
Such systems’ usefulness in nursing relates, in part, to the inability of humans to retain or recall
sufficient quantities of the immense amount of knowledge needed to provide safe care. Decision
support includes
(1) alerts and reminders (e.g., medication due, client has an allergy, potassium level abnormal),
(2) clinical guidelines (e.g., best practice for prevention of skin breakdown),
(3) online information retrieval (e.g., database searches, drug information),
(4) clinical order sets and protocols, and
(5) online access to organizational policies and procedures (Barey, Mastrian, & McGonigle, 2018).
An ideal decision support system is available at the point of care, responds quickly to input, is integrated
into other systems and practices, and is user friendly. In addition, a well-defined, intuitive, and
comprehensive system can streamline communication, reduce errors, improve efficiency, and ultimately
impact patient outcomes.
