NCM 110 -

NURSING INFORMATICS
OBJECTIVES

AT THE END OF LECTURE, THE STUDENT WILL BE ABLE

TO:
1. UNDERSTAND THE USE OF COMPUTER IN
NURSING EDUCATION, PRACTICE AND PROFESSION
2. LEARN THE HISTORY OF NURSING INFORMATICS
3. APPLY BASIC KNOWLEDGE OF COMPUTER IN
NURSING
HISTORICAL OVERVIEW OF NURSING AND COMPUTER
A. COMPUTER
• REFERRED TO AS INFORMATION TECHNOLOGY.
• NETWORKS ARE NOW USED IN COMMUNICATING DATA
VIA THE INTERNET, ACCESSING RESOURCES, AND
INTERACTING WITH PATIENTS ON THE WORLD WIDE
WEB (WWW).
COMPUTER & NURSING

• COMPUTERS IN NURSING 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
B. NURSING INFORMATICS
• A SPECIALTY THAT INTEGRATES NURSING, COMPUTER, AND
INFORMATION SCIENCE TO MANAGE AND COMMUNICATE DATA,
INFORMATION, AND KNOWLEDGE IN NURSING PRACTICE (ANA, 2006).
• FACILITATES THE INTEGRATION OF DATA, INFORMATION, AND
KNOWLEDGE TO SUPPORT PATIENTS, NURSES, AND OTHER
PROVIDERS IN THEIR DECISION-MAKING IN ALL ROLES AND
SETTINGS.
• REFERS TO THE INTEGRATION OF NURSING, ITS INFORMATION AND
INFORMATION MANAGEMENT WITH INFORMATION PROCESSING AND
INFORMATION TECHNOLOGY TO SUPPORT THE HEALTH OF THE
PEOPLE WORLDWIDE.
C. CLINICAL INFORMATION SYSTEM
• REFERS TO A SET OF COMPONENTS THAT FORM THE
MECHANISM BY WHICH PATIENT RECORDS ARE
CREATED, USED, STORED, AND RETRIEVED AND
USUALLY LOCATED WITHIN A HEALTHCARE PROVIDER
SETTING.
• INCLUDES PEOPLE, DATA, RULES AND PROCEDURES,
PROCESSING AND STORAGE DEVICES,
COMMUNICATION, AND SUPPORT FACILITIES (IOM,
1991).
HISTORICAL PERSPECTIVES OF NURSING INFORMATICS

RELATIONSHIPS AND INTERRELATIONSHIPS OF COMPUTER LITERACY, INFORMATION

LITERACY AND NURSING INFORMATICS
• NURSING SCIENCE
A BRANCH OF SCIENCE THAT DEALS WITH THE PRINCIPLES AND
APPLICATIONS OF NURSING AND RELATED SERVICES.

• COMPUTER SCIENCE
THE STUDY OF COMPUTERS AND COMPUTATIONAL SYSTEMS

• INFORMATION SCIENCE
A FIELD PRIMARILY CONCERNED WITH THE ANALYSIS, COLLECTION,
CLASSIFICATION, MANIPULATION, STORAGE, RETRIEVAL, MOVEMENT,
DISSEMINATION, AND PROTECTION OF INFORMATION.
4 MAJOR HISTORICAL PERSPECTIVES

A. SIX TIME PERIOD

B. FOUR MAJOR NURSING AREAS
C. STANDARD INITIATIVES
D. SIGNIFICANT LANDMARK EVENTS
A. SIX TIME PERIOD

1. PRIOR TO 1960S: SIMPLE BEGINNING

• COMPUTERS WERE FIRST DEVELOPED IN THE LATE 1930S TO EARLY 1940S, BUT USE IN
THE HEALTHCARE INDUSTRY OCCURRED IN THE 1950S
• THERE ARE ONLY A FEW EXPERTS WHO ATTEMPTED TO ADAPT COMPUTERS TO HEALTH
CARE
• DURING THIS PERIOD, NURSING PROFESSION IS UNDERGOING MAJOR CHANGES
• INITIALLY, COMPUTERS WERE USED FOR BUSINESS OFFICE TRANSACTIONS.
• EARLY COMPUTERS USED PUNCH CARDS TO STORE DATA AND CARD READERS TO
READ COMPUTER PROGRAMS, SORT, AND PREPARE DATA FOR PROCESSING. IBM
PUNCHED CARDS, HOLLERITH CARDS.
• LINKED TOGETHER AND OPERATED BY PAPER TAPE AND USED TELETYPEWRITERS TO
PRINT THEIR OUTPUT.
• PUNCH CARD–A PIECE OF STIFF PAPER THAT CONTAIN DIGITAL INFORMATION
REPRESENTED BY HOLES IN PREDEFINED POSITION

• CARD READER–READ DATA FROM A CARD SHAPE STORAGE MEDIUM

2. 1960S

• THE USE OF COMPUTER TECHNOLOGY IN HEALTHCARE SETTINGS BEGAN TO BE

QUESTIONED.
• NURSING STANDARDS WERE REVIEWED AND RESOURCES WERE ANALYZED.
• INTRODUCTION OF NEW COMPUTER TECHNOLOGY SUCH AS CATHODE RAY
TUBES (CRT).
• HOSPITAL INFORMATION SYSTEMS WERE DEVELOPED PRIMARILY TO PROCESS
FINANCIAL TRANSACTIONS AND SERVE AS BILLING AND ACCOUNTING SYSTEMS
• VENDORS OF COMPUTER SYSTEMS WERE BEGINNING TO ENTER THE HEALTH
CARE FIELD
• THE NURSES’ STATIONS IN THE HOSPITALS WERE VIEWED AS THE HUB OF
INFORMATION EXCHANGE
A CATHODE RAY TUBE (CRT) IS A GLASS VACUUM TUBE
THAT USES AN ELECTRON BEAM TO CREATE IMAGES ON
A SCREEN. CRTS WERE COMMONLY USED IN
TELEVISIONS AND COMPUTER MONITORS.
3. 1970S: GIANT LEAP OF NI

• HOSPITALS BEGAN DEVELOPING COMPUTER-BASED INFORMATION SYSTEMS

a) PHYSICIAN ORDER ENTRY AND RESULTS REPORTS
b) PHARMACY REPORTS
c) LABORATORY REPORTS
d) RADIOLOGY REPORTS
e) PHYSIOLOGIC MONITORING SYSTEMS IN THE INTENSIVE CARE UNITS
f) STARTED TO INCLUDE CARE PLANNING, DECISION SUPPORT, AND
INTERDISCIPLINARY PROBLEM LISTS.
• HOSPITAL INFORMATION SYSTEMS FURTHER ADVANCED
• THE SEVERAL STATES & LARGE COMMUNITY HEALTH AGENCIES IN THE US
DEVELOPED AND/OR CONTRACTED THEIR OWN COMPUTER-BASED MANAGEMENT
INFORMATION SYSTEMS (MISS)
1970S
• HIS MAINFRAME WERE DESIGNED AND DEVELOPED
• DEVELOPED COMPUTER BASED MANAGEMENT INFORMATION SYSTEMS (MISS)
4. 1980S: EMERGENCE OF INFORMATICS FIELD

• NI BECAME AN ACCEPTED SPECIALTY AND MANY NURSING EXPERTS ENTERED

THE FIELD.
• THE NEED FOR NURSING SOFTWARE EVOLVED AND NURSING EDUCATION
IDENTIFIED THE NEED TO UPDATE PRACTICE STANDARDS, DETERMINE DATA
STANDARDS, VOCABULARIES, AND CLASSIFICATION SCHEMES THAT COULD BE
CODED FOR COMPUTER-BASED PATIENT RECORD SYSTEMS (CPRS).
• NURSING EDUCATION IDENTIFIED THE NEED TO UPDATE PRACTICE STANDARDS,
DETERMINE DATA STANDARDS, VOCABULARIES, AND CLASSIFICATION SCHEMES
THAT COULD BE CODED FOR COMPUTER-BASED PATIENT RECORD SYSTEMS
(CPRSS).
• MICROCOMPUTERS/PCS EMERGED THAT MADE COMPUTERS MORE ACCESSIBLE,
AFFORDABLE, AND USABLE BY NURSES.
• MICROCOMPUTERS/PCS EMERGED THAT MADE COMPUTERS MORE
ACCESSIBLE, AFFORDABLE, AND USABLE BY NURSES.
HISS NURSING SUB SYSTEM:
PATIENTS RECORD ON THE FF:
• ORDER ENTRY
• EMULATING THE KARDEX
• RESULTS REPORTING
• VITAL SIGNS
• OTHER SYSTEMS THAT DOCUMENT NARRATIVE NURSING NOTES
VIA WORD PROCESSING
• DISCHARGE PLANNING
• REFERRALS FOR COMMUNITY HEALTH CARE FACILITIES
5. 1990S: AFFIRMATION OF NI AS A SPECIALTY FIELD

• COMPUTER TECHNOLOGY BECAME AN INTEGRAL PART OF THE HEALTHCARE

SETTINGS, NURSING PRACTICE, AND THE NURSING PROFESSION
• POLICIES AND LEGISLATIONS WERE ADOPTED COMPUTER TECHNOLOGY IN
HEALTH CARE INCLUDING NURSING.
• NI WAS APPROVED BY ANA AS A NEW NURSING SPECIALTY.
• NURSING ADMINISTRATORS DEMANDED THE INCLUSION OF NURSING
PROTOCOLS IN THE HIS.
• NURSING EDUCATORS REQUIRE THE USE OF INNOVATIVE TECHNOLOGIES
FOR ALL LEVELS AND TYPES OF NURSING AND PATIENT EDUCATION.
• THE NEED FOR COMPUTER-BASED NURSING PRACTICE STANDARDS, DATA
STANDARDS, NURSING MINIMUM DATA SETS, AND NATIONAL DATABASES
EMERGED CONCURRENTLY WITH A NEED FOR A UNIFIED NURSING
LANGUAGE.
• NURSE RESEARCHERS REQUIRED KNOWLEDGE PRESENTATION, DECISION
SUPPORT, AND EXPERT SYSTEMS BASED ON AGGREGATED DATA.
• THE DEVELOPMENT OF SMALLER, FASTER COMPUTERS AND INTERNET
CONNECTIONS MADE IT POSSIBLE FOR THE INFORMATION AND KNOWLEDGE
DATABASES TO BE INTEGRATED INTO BEDSIDE SYSTEMS.
• LOCAL AREA NETWORK (LAN) WERE DEVELOPED IN HOSPITALS AND WIDE AREA
NETWORK (WAN) WERE USED TO LINK CARE ACROSS HEALTHCARE FACILITIES
• INTERNET IS WIDELY USED AND HELPED INFORMATION AND KNOWLEDGE
DATABASES TO BE INTEGRATED INTO BEDSIDE SYSTEMS
• WEB BECAME THE MEANS TO COMMUNICATE ONLINE SERVICES AND RESOURCES
TO THE NURSING COMMUNITY
6. POST 2000: RAPID GROWTH AND DEVELOPMENT OF NI

• DEVELOPMENT OF WIRELESS POINT OF CARE, OPEN SOLUTIONS, REGIONAL DATABASE

PROJECTS SOURCE AND SOLUTIONS ON HEALTHCARE INCREASED ENVIRONMENT.
• CLINICAL INFORMATION SYSTEMS INDIVIDUALIZED IN THE ELECTRONIC PATIENT
RECORD (EPR).
• MOBILE TECHNOLOGY ADVANCES: WIRELESS TABLET COMPUTERS, PERSONAL DIGITAL
ASSISTANTS, SMARTPHONES, VOICE OVER INTERNET PROTOCOL (VOIP), HEALTH
SMARTCARDS
• TELENURSING BECAME POPULAR: REMOTE MONITORING OF ICU PATIENTS AND
COMMUNITY PATIENTS
• HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) WAS
ENACTED.
• STANDARDIZED TRANSACTION AND CODE SETS WERE IMPLEMENTED TO PROTECT
SECURITY AND ENSURE PRIVACY AND CONFIDENTIALITY OF HEALTHCARE DATA.
• LEGISLATIONS ON THE US HEALTHCARE INDUSTRY
• PROVIDER IDENTIFICATION NUMBER (PIN)- SAFETY AND
SECURITY OF PATIENTS
• CONSOLIDATED HEALTH INFORMATION (CHI)
• NATIONAL HEALTH INFORMATION INFRASTRUCTURE (NHII)
B. FOUR MAJOR NURSING AREAS

1. NURSING PRACTICE
2. NURSING ADMINISTRATION
3. NURSING EDUCATION
4. NURSING RESEARCH
1. NURSING PRACTICE
• INTEGRATION OF NCPS, PATIENT CARE DATA, THE NURSING PRACTICE ITSELF AS
PART OF THE EHR/ HER.
• NURSING PRACTICE DATA EMERGED WITH THE INTRODUCTION OF SEVERAL
NURSING TERMINOLOGIES USABLE FOR THE EHR.

2. NURSING ADMINISTRATION
• HOSPITAL POLICIES AND PROCEDURE MANUALS ARE ACCESSED AND RETRIEVED BY
COMPUTERS.
• WORK LOAD MEASURES, ACUITY SYSTEMS AND OTHER NURSING DEPARTMENT
SYSTEMS ARE ONLINE AND INTEGRATED WITH THE HOSPITAL OR PATIENT’S HER
SYSTEM OR IN SEPARATE NURSING DEPARTMENT SYSTEMS.
• DIGITAL LIBRARIES, ONLINE RESOURCES AND RESEARCH PROTOCOLS AT THE
BEDSIDE.
“ELECTRONIC
VERSION OF
NURSING
PRACTICE”
3. NURSING EDUCATION
• COMPUTER-ENHANCED COURSES, ONLINE COURSES, AND/ OR DISTANCE
EDUCATION.
• CAMPUS-WIDE COMPUTER SYSTEMS ARE AVAILABLE FOR STUDENTS.
• NEW EDUCATIONAL TEACHING METHODOLOGIES AND STRATEGIES.

4. NURSING RESEARCH
• SOFTWARE PROGRAMS ARE AVAILABLE FOR PROCESSING BOTH
QUALITATIVE AND QUANTITATIVE RESEARCH DATA.
• DATABASES SUPPORTING NURSING RESEARCH EMERGED.
• ONLINE ACCESS TO MILLIONS OF WEB RESOURCES AROUND THE WORLD.
 •LARGE DATABASES
ARE USED FOR META-
ANALYSIS TO DEVELOP
EVIDENCED BASED
PRACTICE GUIDELINES

•INTERNET PROVIDES
ONLINE ACCESS TO
THE MILLION OF WEB
RESOURCES AROUND
THE WORLD
C. STANDARD INITIATIVES

1. NURSING PRACTICE AND EDUCATION

2. NURSING CONTENT STANDARDS
3. CONFIDENTIALITY AND SECURITY STANDARDS
1. NURSING PRACTICE AND EDUCATION
• ANA
• CONTRIBUTES TO THE DEVELOPMENT AND RECOMMENDATION OF
STANDARDS OF NURSING PRACTICE WORLDWIDE.
• NURSING SCOPE & STANDARDS OF PRACTICE (2004).
• RECOMMENDED THAT THE NURSING PROCESS SERVES AS THE
CONCEPTUAL FRAMEWORK FOR THE DOCUMENTATION OF THE NURSING
PRACTICE.
• NURSING INFORMATICS SCOPE AND STANDARDS OF PRACTICE (2008)
• BUILDS ON CLINICAL PRACTICE STANDARDS, OUTLINING FURTHER THE
IMPORTANCE OF IMPLEMENTING STANDARDIZED CONTENT TO SUPPORT
THE NURSING PRACTICE BY NI SPECIALISTS.
• JOINT COMMISSION ON ACCREDITATION OF HOSPITAL ORGANIZATION (JCAHO)
• FOCUSES ON THE NEED FOR ADEQUATE RECORDS ON PATIENTS IN HOSPITALS AND
PRACTICE OF STANDARDS FOR THE DOCUMENTATION OF CARE BY NURSES.
• RECOMMENDED ACUITY SYSTEMS TO DETERMINE RESOURCES USED AS WELL AS
REQUIRED CARE PLANS FOR DOCUMENTING NURSING CARE.

• PNA AND BON

A. PN
• FOUNDED ON SEPTEMBER 2, 1922.
• MEMBER OF THE INTERNATIONAL COUNCIL FOR NURSES.
• INSTIGATED THE STANDARDIZATION OF THE NURSING PROFESSION IN THE PHILIPPINES.
B. BON
• EMPOWERED BY RA 9173.
2. NURSING DATA/CONTENT STANDARDS
• NURSING TERMINOLOGIES APPROVED BY ONE OF THE
AMERICAN NATIONAL STANDARDS INSTITUTES (ANSI) THAT
ACCREDITS STANDARDS DEVELOPING ORGANIZATIONS (SDOS)
OPERATING IN THE HEALTHCARE ARENA
3. CONFIDENTIALITY & SECURITY STANDARDS
• INCREASING ACCESS THROUGH ELECTRONIC CAPTURE AND
EXCHANGE OF INFORMATION RAISED CONCERNS ABOUT THE
PRIVACY AND SECURITY OF PERSONAL HEALTH INFORMATION
(PHI)
• HITECH ACT OF 2009 - INCLUDED THE PROVISIONS FOR
STRENGTHENING THE ORIGINAL HIPAA LEGISLATION (PATIENT
CONSENT, ORGANIZATIONS HANDLING PHI, AND INCREASED
PENALTIES FOR SECURITY BREACHES)
D. MAJOR HISTORICAL LANDMARKS
YEAR EVENT
1961 Health Information & Management System Society (HIMSS)
was founded.
1965 1st Hospital Information System (HIS) at El Camino Hospital.
1973 First Invitation conference on Management Information Systems
(MIS) for public/ community health agencies at Fairfax Virginia.
1977 First Research: State of the Art Conference on Nursing
Information System (NIS), Chicago
1979 First Military Conference for Computer, Washington
1980 First Workshop, University of Akron, Ohio
1981 First National Conference, Bethesda, NIS Journal
1982 The National Conference became an ANNUAL EVENT, New
Jersey
1984 Computers in Nursing: First Nursing Computer Journal
1985 Council on Nursing Informatics was formed in New York
1989 Graduate Program for NI was introduced (Maryland Univ and Univ
of Utah)
1990 ANA Congress of Nursing Practice recognizes Nursing Informatics
as a specialty area
1991 International Classification of Nursing Practice (ICNP) was initiated
1992 ANA recognizes Nursing Informatics as a specialty by delineating
the scope of practice.
1993 Electronic Library goes Online
1995 First International Nursing Informatics, Teleconference (Melbourne
Australia)
1996 First Harriet Werley Award for best nursing informatics paper.
1997 Nursing Information and Data Set Evaluation Center (NIDSEC)
standards and scoring guidelines were published to address
documentation of nursing care.
1999 Nursing Vocabulary Summit Conference Held
2001 Canadian Informatics Nurses Association received emerging
group status from the Canadian Nurses Association.
2002 JCAHO identified clinical information systems as a way to improve
safety and recommended that hospitals adopt
2003 HIPAA deadline for electronic transaction standards enacted in
October.
President calls for widespread adaptation of Electronic Health
Record (EHR) in 10 years.
2004 The office of the National Health Information Coordinator was
established.
HISTORY OF NURSING INFORMATICS IN
THE PHILIPPINES
A. WHAT IS NURSING INFORMATICS?

• IS THE SUB-DISCIPLINE OF HEALTH INFORMATION THAT APPLIES

INFORMATION TECHNOLOGY TO THE SKILLS AND WORK OF NURSES IN
HEALTHCARE.
• IT INTEGRATES THE SCIENCE OF NURSING, COMPUTER TECHNOLOGY
AND INFORMATION SCIENCE TO ENHANCE THE QUALITY OF THE NURSING
PRACTICE, THROUGH IMPROVED COMMUNICATION, DOCUMENTATION
AND EFFICIENCY
2008
• THE WORDS "NURSING INFORMATICS" WERE UNFAMILIAR AMONG THE NURSING
COMMUNITY UNTIL THE YEAR 2008.
• THERE WERE ONLY A HANDFUL OF PEOPLE WITH KNOWLEDGE AND EXPERIENCE IN
NURSING INFORMATICS BUT THE DISCIPLINE HAVE NOT YET FOUND ITS RECOGNITION
AS A SUB-SPECIALTY OF NURSING ARTS AND SCIENCE IN THE COUNTRY.
• THE ORIGIN OF THIS BUDDING DISCIPLINE INDIRECTLY CAME FROM THE PIONEERS OF
HEALTH INFORMATICS IN THE PHILIPPINES.
THE PHILIPPINE MEDICAL INFORMATICS SOCIETY (PMIS) AND ITS FOUNDERS HAD
STRONG INFLUENCE IN THE DEVELOPMENT OF HEALTH INFORMATICS IN THE
PHILIPPINES.
1996
• THE PMIA WAS OFFICIALLY REGISTERED UNDER THE SECURITIES AND EXCHANGE
COMMISSION IN 1996 BY ITS BOARD COMPOSED OF ELEVEN PHYSICIAN. THE
ORGANIZATION WAS HEADED BY DR. ALVIN MARCELO.
B. ORIGIN
1998
• SEVERAL FACULTY MEMBERS OF THE UNIVERSITY OF THE PHILIPPINES
BEGAN FORMAL EDUCATION AND TRAINING.
• DR. HERMAN TOLENTINO TOOK A POST-DOCTORAL FELLOWSHIP IN
MEDICAL INFORMATICS AT THE UNIVERSITY OF WASHINGTON.
• DR. ALVIN MARCELO FOLLOWED A YEAR LATER FOR HIS TRAINING AT THE
NATIONAL LIBRARY OF MEDICINE.
• DR. CITO MARAMBA WENT TO COVENTRY FOR HIS MASTER’S IN
INFORMATION SCIENCES AT THE UNIVERSITY OF WARWICK.
• THEY WERE LATER FOLLOWED BY OTHER PHYSICIANS SUCH AS DR.
MICHEAL MUIN AND DR. RYAN BAÑEZ.
1999
• THE STUDY GROUP WAS FORMED HEADED BY THE NATIONAL INSTITUTE
OF HEALTH OF THE UNIVERSITY OF THE PHILIPPINES MANILA.
• THIS GROUP IDENTIFIED INTERNATIONAL STANDARDS FOR HEALTH
INFORMATION AND ITS ADAPTABILITY IN THE PHILIPPINES.
• THE DOCUMENT IS REFERRED TO AS THE "STANDARDS OF HEALTH
INFORMATION IN THE PHILIPPINES, 1999VERSION" OR "SHIP99"
• REPRESENTATIVES FROM VARIOUS SECTORS COLLABORATED ON THIS
PROJECT INCLUDING THE PHILIPPINE NURSES ASSOCIATION (PNA) IN
THE PERSON OF MS. EVELYN PROTACIO.
2003
• MASTER OF SCIENCE IN HEALTH INFORMATICS
▪ WAS PROPOSED TO BE OFFERED BY UP-MANILA COLLEGE OF
MEDICINE (MAJOR IN MEDICAL INFORMATICS) AND THE COLLEGE OF ARTS
AND SCIENCE (MAJOR IN BIOINFORMATICS)
▪ WAS LATER APPROVED TO BE OFFERED DURING THE ACADEMIC
YEAR 2005-2006.
C. CHED AS CATALYST

• THE NURSING COMMUNITY WAS STILL YET TO FOLLOW ITS

INTERNATIONAL COUNTERPARTS IN THE ADOPTION OF INFORMATION,
COMMUNICATION, AND TECHNOLOGY IN NURSING PRACTICE IN THE
PHILIPPINES.
• DESPITE THE INCLUSION OF INFORMATICS COURSES IN THE
UNDERGRADUATE CURRICULUM WHICH FOCUSED ON BASIC DESKTOP
APPLICATIONS, THE NEED FOR GENUINE NURSING INFORMATICS
COURSES HAD NOT YET BEEN REALIZED.
• 2008
• NURSING INFORMATICS COURSE IN THE UNDERGRADUATE CURRICULUM
WAS DEFINED BY THE COMMISSION ON HIGHER EDUCATION (CHED)
MEMORANDUM ORDER 5 SERIES OF 2008.
• THIS WAS LATER REVISED AND INCLUDED AS HEALTH INFORMATICS
COURSE IN CHED MEMORANDUM ORDER 14 SERIES OF 2009.
• THIS IS FIRST IMPLEMENTED IN THE SUMMER OF 2010.
D. ORGANIZATION

2009
• MR. KRISTIAN R. SUMABAT AND MS. MIA ALCANTARA-SANTIAGO, - BOTH
NURSES AND GRADUATE STUDENTS OF MASTER OF SCIENCE IN HEALTH
INFORMATICS AT THE UNIVERSITY OF THE PHILIPPINES, MANILA BEGAN
DRAFTING PLANS TO CREATE A NURSING INFORMATICS ORGANIZATION.
FEBRUARY 2010
• THEY BEGAN RECRUITING OTHER NURSING INFORMATICS SPECIALISTS
AND PRACTITIONERS TO ORGANIZE A GROUP WHICH LATER BECAME THE
PHILIPPINE NURSING INFORMATICS ASSOCIATION.
• THEY WERE JOINED BY FOUNDING MEMBERS:
• MS. SHERYL OCHEA, A GRADUATE OF MASTER OF SCIENCE IN NURSING
MAJOR IN NURSING INFORMATICS AT XAVIER UNIVERSITY (OHIO, USA)
• MS. ALEXRANDRA BERNAL, A GRADUATE STUDENT AND TELEHEALTH
NURSE OF THE NATIONAL TELEHEALTH CENTER
• MS. PIA PELAYO, A FORMER TELEHEALTH NURSE AND A PROJECT
COORDINATOR OF THE NATIONAL EPIDEMIOLOGY CENTER, DEPARTMENT
OF HEALTH
• MR. SID CARDENAS IS ALSO A TELEHEALTH NURSE.
• OTHER FOUNDING MEMBERS INCLUDE MR. NOEL BAÑEZ, MS. RONA
ABCEDE, AND MR. HARBY ONGBAY -ABELLANOSA
E. ISSUES AND CHALLENGES

LIKE MANY OTHER DISCIPLINES, NURSING INFORMATICS FACE MANY CHALLENGES WHILE IN
ITS INFANCY STAGE.
• THE INCLUSION OF INFORMATICS AS AN INTEGRAL PART OF THE UNDERGRADUATE
CURRICULUM HAS BEEN ONE OF THE MOST INFLUENTIAL FACTORS FOR THE INCREASED
AWARENESS AND INTEREST IN THIS FIELD OF NURSING.
• HOWEVER, THE CONTENTS OF THE CURRICULUM WAS ADAPTED FROM INTERNATIONAL
MATERIALS WHICH DOES NOT MATCH THE LOCAL NEEDS.
• A COMMUNITY-CENTERED APPROACH TO THE USE OF INFORMATION, COMMUNICATION AND
TECHNOLOGY IN NURSING PRACTICE MUST BE ADAPTED TO ENSURE THE IMPACT OF THE
PROGRAM IN THE LOCAL HEALTHCARE SYSTEM.
• LACK OF CERTIFICATION AND CREDENTIALING PROGRAMS IN POST-GRADUATE LEVELS ARE
ALSO ABSENT WITH THE SCARCITY OF LOCAL NURSING INFORMATICS EXPERTS.
• THIS NEW FIELD HAS YET TO GAIN ACCEPTANCE AND RECOGNITION IN THE NURSING
COMMUNITY AS A SUB-SPECIALTY
CONCEPTS, PRINCIPLES, AND THEORIES IN
NURSING INFORMATICS
MAJOR THEORIES AND MODELS SUPPORTING NURSING
INFORMATICS:
A. GENERAL SYSTEMS THEORY
B. CHANGE THEORY
C. COGNITIVE LEARNING THEORY
D. NOVICE TO EXPERT THEORY
E. DIKW THEORY
F. GRAVES AND CORCORANS MODEL
G. SCHWIRIANS MODEL
H. TURLEY’S MODEL
A. GENERAL SYSTEMS THEORY
• INCLUDES PURPOSE, CONTENT AND PROCESS, BREAKING DOWN
THE “WHOLE” AND ANALYZING THE PARTS.
• THE RELATIONSHIP BETWEEN THE PARTS OF THE WHOLE ARE
EXAMINED TO LEARN HOW THEY WORK TOGETHER.
• A SYSTEM IS MADE UP OF SEPARATE COMPONENTS. THE PARTS
RELY ON ONE ANOTHER, ARE INTERRELATED, SHARE A COMMON
PURPOSE, AND TOGETHER FORM A WHOLE.
• INPUT IS THE INFORMATION THAT ENTERS THE SYSTEM.
• OUTPUT IS THE END PRODUCT OF A SYSTEM.
• FEEDBACK IS THE PROCESS THROUGH WHICH THE OUTPUT IS
RETURNED TO THE SYSTEM.
VON BERTALANFFY (1969, 1976) DEVELOPED GENERAL
SYSTEM THEORY, WHICH HAS THE FOLLOWING
ASSUMPTIONS:
A. ALL SYSTEMS MUST BE GOAL DIRECTED
B. A SYSTEM IS MORE THAN THE SUM OF ITS PARTS
C. A SYSTEM IS EVERCHANGING AND ANY CHANGE IN
ONE PART AFFECTS THE WHOLE
D. BOUNDARIES ARE IMPLICIT AND HUMAN SYSTEMS
ARE OPEN AND DYNAMIC.
 TERM DEFINITION EXAMPLES
INPUT The energy & raw material transformed Information, money, energy, time, individual effort, &
by the system raw materials of some kind.
THROUGPUT The process used by the system to Thinking, planning, decision-making, constructing,
convert raw materials or energy from the sorting, sharing, information, meeting in groups,
environment into products that are usable discussing, melting, shaping, hammering, etc.
by either the system itself or the
environment.
OUTPUT The product or service which results from Software programs, documents, decisions, laws, rules,
the system’s throughput or processing of money, assistance, cars, clothing, bills, etc.
technical, social, financial & human input.
FEEDBACK Information about some aspect of data How many cars were produced?
or energy processing that can be used to How many had to be recalled correct errors?
evaluate & monitor the system & to How many mistakes were made?
guide Why were mistakes made?
it to more effective performance. HealthCareReportCard.com is an example of how
hospitals are doing with certain diagnoses.
Accreditation reports are an example as are patient
satisfaction surveys, sales reports, and test results.
 TERM DEFINITION EXAMPLES
SUBSYSTEM A system which is a part of a larger The finance department, the information system,
system. They can work parallel to each the managerial system, the renal system, the
other or in a series with each other. political system, the workflow system (such as the
conveyor belt), etc.
STATIC Neither system elements nor the system A rock
SYSTEM itself changes much over time in
relation to the environment.
DYNAMIC The system constantly changes the A healthy young adult grows more independent,
SYSTEM environment & is changed by the interdependent, & self-sufficient & self-directed in
environment. response to stimuli from peers, family, school,
work, & recreational activities.
CLOSED Fixed, automatic relationship among A rock is an example of the most closed system.
SYSTEMS system components & no give or take We may encounter families that are isolated from
with the environment. the community & the resistant to any outside
influence.
 TERM DEFINITION EXAMPLES
OPEN Interacts with the environment trading Hospitals, families, people, body systems, banks,
SYSTEMS energy & raw material for goods & manufacturing plants, governmental bodies,
services produced by the system. They are associations, business, etc.
self-regulating, & capable of growth,
development & adaptation.
BOUNDARY The line or point where a system or The nursing unit, the occupational therapy department,
subsystem can be differentiated from its the elementary school, a person, an agency, or business,
environment or from other subsystems. Can a fence or wall, roles, etc.
be rigid or permeable or some point in
between. Systems or subsystems will
engage in boundary tending
GOAL The overall purpose for existence or the To educate students to support people during illness &
desired outcomes. The reason for being. restore them to health, to make money, to create social
Currently, many organizations put their order, etc
goals into a mission statement.
ENTROPY The tendency for a system to develop Rules are made, policies & protocols are written,
order & energy over time. approved & communicated to staff; laws are enacted &
violators are held accountable; a marathon runner in
training gradually is able to run farther.
BASIC PRINCIPLE OF A SYSTEM APPROACH
A SYSTEM IS GREATER THAN THE SUM OF ITS PARTS. REQUIRES INVESTIGATION OF
THE WHOLE SITUATION RATHER THAN ONE (1) OR TWO (2) ASPECTS OF A PROBLEM.
THE PORTION OF THE WORLD STUDIED (SYSTEM) MUST EXHIBIT SOME
PREDICTABILITY.
THOUGH EACH SUB-SYSTEM IS A SELF-CONTAINED UNIT, IT IS PART OF A WIDER AND
HIGHER ORDER.
THE CENTRAL OBJECTIVE OF A SYSTEM CAN BE IDENTIFIED BY THE FACT THAT THE
OTHER OBJECTIVES WILL BE SACRIFICED IN ORDER TO ATTAIN THE CENTRAL
OBJECTIVE.
EVERY SYSTEM, LIVING OR MECHANICAL, IS AN INFORMATION SYSTEM. MUST
ANALYZE HOW SUITABLE THE SYMBOLS USED ARE FOR INFORMATION TRANSMISSION.
AN OPEN SYSTEM AND ITS ENVIRONMENT ARE HIGHLY INTERRELATED.
A HIGHLY COMPLEX SYSTEM MAY HAVE TO BE BROKEN INTO SUBSYSTEM
SO EACH CAN BE ANALYZED AND UNDERSTOOD BEFORE BEING
REASSEMBLED ONTO A WHOLE.
A SYSTEM CONSISTS OF A SET OF OBJECTIVES AND THEIR
RELATIONSHIPS.
WHEN SUBSYSTEMS ARE ARRANGED IN A SERIES , THE OUTPUT OF ONE
IS THE INPUT FOR ANOTHER; THEREFORE, PROCESS ALTERATIONS IN
ONE REQUIRES ALTERATIONS ON OTHER SUBSYSTEMS
ALL SYSTEMS TEND TOWARD EQUILIBRIUM, WHICH IS A BALANCE OF
VARIOUS FORCES WITHIN AND OUTSIDE OF A SYSTEM.
THE BOUNDARY OF A SYSTEM CAN BE REDRAWN AT WILL BY A SYSTEM
ANALYST.
TO BE VIABLE, A SYSTEM MUST BE STRONGLY GOAL-DIRECTED,
GOVERNED BY FEEDBACK, AND HAVE THE ABILITY TO ADAPT TO
CHANGING CIRCUMSTANCES.
B. CHANGE THEORY
• WAS DEVELOPED BY KURT LEWIN- CONSIDERED THE
FATHER OF SOCIAL PSYCHOLOGY.
• A MOST INFLUENTIAL THEORY OF KURT LEWIN.
• THREE-STAGE MODEL OF CHANGE: UNFREEZING-
CHANGE-REFREEZE. “A DYNAMIC BALANCE OF
FORCES WORKING IN OPPOSING DIRECTIONS.”
THREE MAJOR CONCEPTS:
• DRIVING FORCES - ARE THOSE THAT PUSH IN A DIRECTION THAT
CAUSES CHANGE TO OCCUR. THEY CAUSE A SHIFT IN THE
EQUILIBRIUM TOWARDS CHANGE.
• RESTRAINING FORCES - ARE THOSE FORCES THAT COUNTER
THE DRIVING FORCES. THEY HINDER CHANGE BECAUSE THEY
PUSH THE PATIENT IN THE OPPOSITE DIRECTION. THEY CAUSE A
SHIFT IN THE EQUILIBRIUM THAT OPPOSES CHANGE.
• EQUILIBRIUM - IS A STATE OF BEING WHERE DRIVING FORCES
EQUAL RESTRAINING FORCES, AND NO CHANGE OCCURS. IT CAN
BE RAISED OR LOWERED BY CHANGES
THREE STAGES CONCEPTS:
• UNFREEZING- IS THE PROCESS WHICH INVOLVES
FINDING A METHOD OF MAKING IT POSSIBLE FOR
PEOPLE TO LET GO OF AN OLD PATTERN THAT WAS
SOMEHOW COUNTERPRODUCTIVE.
• THE CHANGE STAGE, WHICH IS ALSO CALLED “
MOVING TO A NEW LEVEL” OR “MOVEMENT. ”
• REFREEZING STAGE - IS ESTABLISHING THE CHANGE
AS THE NEW HABIT.
MAJOR ASSUMPTIONS:
• PEOPLE GROW AND CHANGE THROUGHOUT THEIR LIVES.
THIS GROWTH AND CHANGE ARE EVIDENT IN DYNAMIC
NATURE OF BASIC HUMAN NEEDS AND HOW THEY ARE
MET.
• CHANGE HAPPENS DAILY. IT IS SUBTLE, CONTINUOUS AND
MANIFESTED IN BOTH EVERYDAY OCCURRENCES AND
MORE DISRUPTIVE LIFE EVENTS.
• REACTIONS TO CHANGE ARE GROUNDED IN THE BASIC
HUMAN NEEDS FOR SELF-ESTEEM, SAFETY AND SECURITY.
• CHANGE INVOLVES MODIFICATION OR ALTERATION. IT MAY
BE PLANNED OR UNPLANNED.
KURT LEWIN (1962) DEVELOPED THE CHANGE THEORY, WHICH
IDENTIFIES THE FOLLOWING SIX COMPONENTS:
1. RECOGNITION OF THE AREA WHERE CHANGE IS NEEDED.
2. ANALYSIS OF A SITUATION TO DETERMINE WHAT FORCES EXIST
TO MAINTAIN THE SITUATION AND WHAT FORCES ARE WORKING
TO CHANGE IT.
3. IDENTIFICATION OF METHODS BY WHICH CHANGE CAN OCCUR.
4. RECOGNITION OF THE INFLUENCE OF GROUP MORES OR
CUSTOMS ON CHANGE.
5. IDENTIFICATION OF THE METHODS THAT THE REFERENCE
GROUP USES TO BRING ABOUT CHANGE.
6. THE ACTUAL PROCESS OF CHANGE.
C. COGNITIVE LEARNING THEORY
• THE COGNITIVE LEARNING THEORY EXPLAINS WHY THE BRAIN IS
THE MOST INCREDIBLE NETWORK OF INFORMATION
PROCESSING IN THE BODY AS WE LEARN THINGS. THIS THEORY
CAN BE DIVIDED INTO TWO SPECIFIC THEORIES:
• THE SOCIAL COGNITIVE THEORY (SCT), AND THE COGNITIVE
BEHAVIORAL THEORY (CBT).
A. SOCIAL COGNITIVE THEORY (SCT)
3 VARIABLES:
• BEHAVIORAL FACTORS
• ENVIRONMENTAL FACTORS (EXTRINSIC)
• PERSONAL FACTORS (INTRINSIC)
SOCIAL COGNITIVE THEORY ILLUSTRATION (PAJARES, 2002)
• IN THE PERSON-ENVIRONMENT INTERACTION, HUMAN
BELIEFS, IDEAS AND COGNITIVE COMPETENCIES ARE
MODIFIED BY EXTERNAL FACTORS SUCH AS A SUPPORTIVE
PARENT, STRESSFUL ENVIRONMENT OR A HOT CLIMATE. IN
THE PERSON-BEHAVIOR INTERACTION, THE COGNITIVE
PROCESS OF A PERSON AFFECT HIS BEHAVIOR, LIKEWISE,
PERFORMANCE OF SUCH BEHAVIOR CAN MODIFY THE WAY
HE THINKS. LASTLY, THE ENVIRONMENT-BEHAVIOR
INTERACTION, EXTERNAL FACTORS CAN ALTER THE WAY
YOU DISPLAY THE BEHAVIOR. ALSO YOUR BEHAVIOR CAN
AFFECT AND MODIFY YOUR ENVIRONMENT.
BASIC CONCEPTS
- SOCIAL COGNITIVE THEORY INCLUDES SEVERAL BASIC CONCEPTS
THAT CAN MANIFEST NOT ONLY IN ADULTS BUT ALSO IN INFANTS,
CHILDREN AND ADOLESCENTS.
A. OBSERVATIONAL LEARNING
• LEARNING FROM OTHER PEOPLE BY MEANS OF OBSERVING THEM IS
AN EFFECTIVE WAY OF GAINING KNOWLEDGE AND ALTERING
BEHAVIOR.
B. REPRODUCTION
• THE PROCESS WHEREIN THERE IS AN AIM TO EFFECTIVELY INCREASE
THE REPEATING OF A BEHAVIOR BY MEANS OF PUTTING THE
INDIVIDUAL IN A COMFORTABLE ENVIRONMENT WITH READILY
ACCESSIBLE MATERIALS TO MOTIVATE HIM TO RETAIN THE NEW
KNOWLEDGE AND BEHAVIOR LEARNED AND PRACTICE THEM.
C. SELF EFFICACY
• THE COURSE WHEREIN THE LEARNER IMPROVES HIS NEWLY
KNOWLEDGE OR BEHAVIOR BY PUTTING IT INTO PRACTICE.
D. EMOTIONAL COPING
• GOOD COPING MECHANISMS AGAINST STRESSFUL
ENVIRONMENT AND NEGATIVE PERSONAL CHARACTERISTICS
CAN LEAD TO EFFECTIVE LEARNING, ESPECIALLY IN ADULTS.
E. SELF-REGULATORY CAPABILITY
• ABILITY TO CONTROL BEHAVIOR EVEN WITHIN AN
UNFAVORABLE ENVIRONMENT.
B. BEHAVIORAL COGNITIVE THEORY
• COGNITIVE BEHAVIORAL THEORY DESCRIBES THE
ROLE OF COGNITION (KNOWING) TO DETERMINING
AND PREDICTING THE BEHAVIORAL PATTERN OF AN
INDIVIDUAL. THIS THEORY WAS DEVELOPED BY AARON
BECK.
• THE COGNITIVE BEHAVIORAL THEORY SAYS THAT
INDIVIDUAL TEND TO FORM SELF-CONCEPTS THAT
AFFECT THE BEHAVIOR THEY DISPLAY. THESE
CONCEPTS CAN BE POSITIVE OR NEGATIVE AND CAN
BE AFFECTED BY A PERSON’S ENVIRONMENT.
D. THE NOVICE TO EXPERT THEORY
• A CONSTRUCT THEORY FIRST PROPOSED BY HUBERT AND STUART DREYFUS
(1980) AS THE DREYFUS MODEL OF SKILL ACQUISITION, AND LATER APPLIED
AND MODIFIED TO NURSING BY PATRICIA BENNER (1984) PROVIDES A VERY
USEFUL AND IMPORTANT THEORY THAT CLEARLY APPLIES TO NURSING
INFORMATICS.
• WITHIN THE FIELD OF NURSING INFORMATICS, THIS THEORY CAN BE APPLIED
TO:
1. THE DEVELOPMENT OF NURSING INFORMATICS SKILLS, COMPETENCIES,
KNOWLEDGE AND EXPERTISE IN NURSING INFORMATICS SPECIALISTS;
2. THE DEVELOPMENT OF TECHNOLOGICAL SYSTEM COMPETENCIES IN
PRACTICING NURSES WORKING IN AN INSTITUTION;
3. THE EDUCATION OF NURSING STUDENTS, FROM FIRST YEAR TO GRADUATION
AND;
4. THE TRANSITION FROM GRADUATE NURSE TO EXPERT NURSE.
NOVICE TO EXPERT
• THE CURRENTLY ACCEPTED FIVE
LEVELS OF DEVELOPMENT WITHIN
THE NOVICE TO EXPERT
THEORETICAL MODEL ARE
ILLUSTRATED IN THE IMAGE, AS
PRESENTED BY BENNER (1984).
THEY START FROM THE BOTTOM
RUNG AT THE NOVICE LEVEL AND
MOVE UPWARD THROUGH
ADVANCED BEGINNER,
COMPETENT, PROFICIENT, AND
EXPERT LEVELS.
DISTINGUISHING FEATURES
• TWO PERSONAL CHARACTERISTICS THAT DISTINGUISH THE
SUCCESSFUL TO THE EXPERT LEVEL SEEM TO BE
• 1. DELIBERATE PRACTICE AND
• 2. THE WILLINGNESS TO TAKE RISKS, TO GO BEYOND THE NORM.

TAKING RISKS
• –THIS CONTINUOUS CLIMB TO THE EXPERT LEVEL IS NOT
WITHOUT PERCEIVED RISKS- IT REQUIRES PEOPLE TO MOVE
BEYOND THE STATUS QUO OF MERE COMPETENCE THROUGH
THE LEVELS OF PROFICIENCY, THEN EXPERTISE
SOME COMMON THEMES ARE EVIDENT AS A PERSON SUCCESSFULLY
PROGRESSES THROUGH THE NOVICE TO EXPERT LEVELS:
 AS PROGRESSION OCCURS, THE PERSON TENDS TO MOVE AWAY
FROM RELYING ON RULES AND EXPLICIT KNOWLEDGE TO LEARNING
TO TRUST AND FOLLOW THEIR INTUITION AND PATTERN MATCHING.
 BETTER COGNITIVE FILTERING OCCURS, WHERE PROBLEMS ARE
NO LONGER A HUGE CONFUSING COLLECTION OF DATA BUT
INSTEAD BECOME A COMPLETE AND UNIQUE WHOLE WHERE SOME
BITS ARE MUCH MORE RELEVANT THAN OTHERS.
 THE PERSON ALSO MOVES FROM BEING A DETACHED OBSERVER
OF A PROBLEM TO AN INVOLVED PART OF THE SYSTEM ITSELF,
ACCEPTING RESPONSIBILITY FOR RESULTS, NOT JUST FOR
CARRYING OUT TASKS.
NOVICE
• A NOVICE DOES NOT KNOW ANYTHING ABOUT THE
SUBJECT HE/SHE IS APPROACHING AND HAS TO
MEMORIZE ITS CONTEXT-FREE FEATURES.
• THE NOVICE IS THEN GIVEN RULES FOR DETERMINING AN
ACTION ON THE BASIS OF THESE FEATURES.
ADVANCED BEGINNER
• AN ADVANCED BEGINNER IS STILL DEPENDENT ON RULES,
BUT AS HE/SHE GAINS MORE EXPERIENCE WITH REAL-LIFE
SITUATIONS, HE/SHE BEGINS TO NOTICE ADDITIONAL
ASPECTS THAT CAN BE APPLIED TO RELATED CONDITIONS.
COMPETENT
• THE COMPETENT PERSON GRASPS ALL THE RELEVANT
RULES AND FACTS OF THE FIELD AND IS, FOR THE FIRST
TIME, ABLE TO BRING HIS/HER OWN JUDGMENT TO EACH
CASE. THIS IS THE STAGE OF LEARNING THAT IS OFTEN
CHARACTERIZED BY THE TERM – PROBLEM-SOLVING.
PROFICIENT
• CHARACTERIZED BY THE PROGRESS OF THE LEARNER
FROM THE STEP-BY-STEP ANALYSIS AND SOLVING OF THE
SITUATION TO THE HOLISTIC PERCEPTION OF THE
ENTIRETY OF THE SITUATION.
EXPERT
• AN EXPERT’S REPERTOIRE OF EXPERIENCED
SITUATIONS IS SO VAST THAT NORMALLY EACH
SPECIFIC SITUATION IMMEDIATELY DICTATES AN
INTUITIVELY APPROPRIATE ACTION.
E. THE DIKW THEORY
• WHEN RAW DATA IS COLLECTED, IT GETS MIXED UP AND
THE VIEW SEEMS JUMBLED. THE DIKW MODEL BY FRICKE
(2018) ON RUSSELL ACKOFF (1989) DESCRIBES HOW THE
DATA CAN BE PROCESSED AND TRANSFORMED INTO
INFORMATION, KNOWLEDGE, AND WISDOM.
• THE DIKW HIERARCHY COMPROMISES THE FOLLOWING:
“D” = DATA
“I” = INFORMATION
“K” = KNOWLEDGE
“W” = WISDOM
1. DATA
• FIRST STEP IN DIKW MODEL.
• COLLECTION OF RAW DATA IS THE MAIN REQUIREMENTS
FOR COMING UP A MEANINGFUL RESULT IN THE END. ANY
MEASUREMENTS, LOGGING, TRACKING, RECORDS, AND
MANY OTHERS ARE ALL CONSIDERED AS DATA.
2. INFORMATION
• THE DATA THAT HAS BEEN GIVEN A MEANING BY DEFINING
RELATIONAL CONNECTIONS. THE WORD “MEANING”
REPRESENTS PROCESSED AND UNDERSTANDABLE DATA
THAT MAY OR MAY NOT BE A USEFUL PIECE OF CONTENT
FROM THE ORGANIZATION PERSPECTIVE.
3. KNOWLEDGE
• THIRD LEVEL OF DIKW MODEL.
• KNOWLEDGE MEANS THE APPROPRIATE COLLECTION OF INFORMATION THAT
CAN MAKE IT BE USEFUL.
• IT IS A DETERMINISTIC PROCESS. WHEN SOMEONE “MEMORIZES”
INFORMATION DUE TO ITS USEFULNESS, THEN IT CAN BE SAID THAT THEY
HAVE ACCUMULATED KNOWLEDGE.
4. WISDOM
• FOURTH LEVEL AND LAST STEP OF DIKW HIERARCHY.
• IT IS A PROCESS TO GET THE FINAL RESULT BY CALCULATING THROUGH
EXTRAPOLATION OF KNOWLEDGE.
• IT CONSIDERS THE OUTPUT FROM ALL THE PREVIOUS LEVELS OF DIKW MODEL
AND PROCESS THEM THROUGH SPECIAL TYPES OF HUMAN PROGRAMMING.
F. GRAVES AND CORCORAN’S MODEL (1989; 1995)
• ACCORDING TO THIS MODEL, NURSING INFORMATICS AS THE LINEAR
PROGRESSION, FROM DATA INTO INFORMATION AND KNOWLEDGE.

MANAGEMENT PROCESSING
• IS INTEGRATED WITHIN EACH ELEMENTS, DEPICTING NURSING
INFORMATICS AS THE PROPER MANAGEMENT OF KNOWLEDGE , FROM
DATA AS IT IS CONVERTED INTO INFORMATION AND KNOWLEDGE.
G. SCHIWIRIAN'S MODEL (1986)
• ACCORDING TO THIS MODEL, NURSING INFORMATICS
INVOLVES IDENTIFICATION OF INFORMATION NEEDS,
RESOLUTION OF THE NEEDS, AND ATTAINMENT OF NURSING
GOALS/OBJECTIVES.

• PATRICIA SCHWIRIAN PROPOSED A MODEL INTENDED TO

STIMULATE AND GUIDE SYSTEMATIC RESEARCH IN NURSING
INFORMATICS, MODEL/FRAMEWORK THAT ENABLE
IDENTIFICATION OF SIGNIFICANT INFORMATION NEEDS, THAT
CAN FOSTER RESEARCH
FOUR PRIMARY ELEMENTS
1. THE RAW MATERIAL – WHICH IS NURSING RELATED
INFORMATION.
2. THE TECHNOLOGY – WHICH IS THE COMPUTING SYSTEM.
3. THE USERS – WHO ARE NURSES/STUDENTS WITHIN THE
CONTEXT OF THEIR PERSONAL AND PROFESSIONAL
SYSTEMS
4. THE GOAL OR OBJECTIVE – WHICH THE THREE
PRECEDING ELEMENTS ARE DIRECTED.
H. TURLEY'S MODEL (1996)
• NURSING INFORMATICS IS THE INTERSECTION
BETWEEN THE DISCIPLINE-SPECIFIC SCIENCE
(NURSING) AND THE AREA OF INFORMATICS.
• AND IN THIS MODEL, THERE ARE 3 CORE COMPONENTS
OF INFORMATICS, NAMELY COGNITIVE SCIENCE,
INFORMATION SCIENCE, AND COMPUTER SCIENCE.
COMPUTER AND THE COMPUTER
HARDWARE AND SOFTWARE
• COMPUTER HARDWARE IS DEFINED AS ALL OF THE
PHYSICAL COMPONENTS OF A COMPUTER.

• A COMPUTER IS AN ELECTRONIC DEVICE, OPERATING

UNDER THE CONTROL OF INSTRUCTIONS (SOFTWARE)
STORED IN ITS OWN MEMORY UNIT, THAT CAN ACCEPT
DATA (INPUT), MANIPULATE DATA (PROCESS), AND
PRODUCE INFORMATION (OUTPUT) FROM THE
PROCESSING.
REQUIRED HARDWARE COMPONENTS OF A
COMPUTER

• MOTHERBOARD
THE BOX OF ANY COMPUTER CONTAINS A
MOTHERBOARD. THE MOTHERBOARD IS A THIN, FLAT
SHEET MADE OF A FIRM, NONCONDUCTING MATERIAL
ON WHICH THE INTERNAL COMPONENTS—PRINTED
CIRCUITS, CHIPS, SLOTS, AND SO ON—OF THE
COMPUTER ARE MOUNTED.
• MEMORY
MEMORY REFERS TO THE ELECTRONIC STORAGE
DEVICES OR CHIPS ON THE MOTHERBOARD OF A
COMPUTER. THERE ARE THREE KEY TYPES OF
MEMORY IN A COMPUTER. THEY ARE READ- ONLY
MEMORY (ROM), THE MAIN MEMORY KNOWN AS
RANDOM ACCESS MEMORY (RAM), AND CACHE.
• READ - ONLY MEMORY - A FORM OF PERMANENT
STORAGE IN THE COMPUTER. IT CARRIES
INSTRUCTIONS THAT ALLOW THE COMPUTER TO
BE BOOTED (STARTED), AND OTHER ESSENTIAL
MACHINE INSTRUCTIONS. ITS PROGRAMMING IS
STORED BY THE MANUFACTURER AND CANNOT
BE CHANGED BY THE USER.
• RANDOM ACCESS MEMORY - RANDOM ACCESS
MEMORY(RAM) REFERS TO WORKING MEMORY
USED FOR PRIMARY STORAGE. IT IS USED AS
TEMPORARY STORAGE. ALSO KNOWN AS MAIN
MEMORY, RAM CAN BE ACCESSED, USED,
CHANGED, AND WRITTEN ON REPEATEDLY.
• CACHE - CACHE IS A SMALLER FORM OF RAM. ITS
PURPOSE IS TO SPEED UP PROCESSING BY
STORING FREQUENTLY CALLED ITEMS IN A
SMALL, RAPID ACCESS MEMORY LOCATION.
• INPUT AND OUTPUT
INPUT AND OUTPUT DEVICES ARE WIRED TO A
CONTROLLER THAT IS PLUGGED INTO THE SLOTS OR
CIRCUIT BOARDS OF THE COMPUTER. SOME
DEVICES CAN SERVE AS BOTH INPUT AND OUTPUT
DEVICES—FOR EXAMPLE, THE HARD DRIVE IN WHICH
MOST OF THE PROGRAMS ARE STORED RECEIVE
AND STORE INFORMATION AS WELL AS SEND THEIR
PROGRAMS TO THE COMPUTER.
• INPUT DEVICES - THESE DEVICES ALLOW THE
COMPUTER TO RECEIVE INFORMATION FROM THE
OUTSIDE WORLD.
EXAMPLES ARE KEYBOARD, MOUSE, LIGHT PEN, TOUCH
SCREEN, VOICE AND SCANNER
• OUTPUT DEVICES - THESE DEVICES ALLOW THE
COMPUTER TO REPORT ITS RESULTS TO THE
EXTERNAL WORLD. OUTPUT DEVICES ARE DEFINED AS
ANY EQUIPMENT THAT TRANSLATES THE COMPUTER
INFORMATION INTO SOMETHING READABLE BY PEOPLE
OR OTHER MACHINES.
• OUTPUT CAN BE IN THE FORM OF TEXT, DATA FILES, SOUND,
GRAPHICS, OR SIGNALS TO OTHER DEVICES. THE MOST
OBVIOUS OUTPUT DEVICES ARE THE MONITOR AND PRINTER
• STORAGE MEDIA
STORAGE INCLUDES THE MAIN MEMORY BUT
ALSO EXTERNAL DEVICES ON WHICH PROGRAMS
AND DATA ARE STORED. THE MOST COMMON
STORAGE DEVICE IS THE COMPUTER’S HARD
DRIVE. OTHER COMMON MEDIA INCLUDE
EXTERNAL HARD DRIVES, FLASH DRIVES, AND
READ/WRITE DIGITAL VERSATILE DISKS (DVDS)
AND COMPACT DISKS (CDS).
• HARD DRIVE - THE HARD DRIVE IS A PERIPHERAL
DEVICE THAT HAS VERY HIGH SPEED AND HIGH
DENSITY. THE HARD DRIVE IS THE MAIN STORAGE
DEVICE OF A COMPUTER.
• A USB FLASH DRIVE IS ACTUALLY A FORM OF A SMALL,
REMOVABLE HARD DRIVE THAT IS INSERTED INTO THE
USB PORT OF THE COMPUTER. THE USB DRIVE IS ALSO
KNOWN AS PEN DRIVE, JUMP DRIVE, THISTLE DRIVE,
POCKET DRIVE, AND SO FORTH.
• CLOUD STORAGE - AN EXTENSION OF THE
ONLINE STORAGE SERVICE OFFERED BY
INDIVIDUAL VENDORS IS CLOUD STORAGE.
MAJOR TYPES OF COMPUTERS
1. SUPERCOMPUTERS -
LARGEST TYPE OF COMPUTER
SPECIALLY DESIGNED FOR
SCIENTIFIC APPLICATIONS
REQUIRING GIGANTIC AMOUNT
OF DATA CALCULATIONS
2. MAINFRAME
COMPUTERS - USE BY
LARGE ORGANIZATIONS
SUCH AS BANKS TO
CONTROL THE ENTIRE
BUSINESS OPERATION.
3. MICROCOMPUTERS /
PERSONAL COMPUTERS
(PCS) - COMPUTERS THAT
PROCESS SPECIFIC
APPLICATION. OFTEN
USED AS STAND-ALONE
COMPUTERS OR IN A
NETWORK.
4. HANDHELD
COMPUTERS - SMALL
COMPUTERS. HAVE
ALMOST THE SAME
FUNCTIONALITY AND
PROCESSING
CAPABILITIES AS THE
STANDARD
MICROCOMPUTERS.
SOFTWARE
IT IS THE GENERAL TERM APPLIED TO THE
INSTRUCTIONS THAT DIRECT THE COMPUTER’S
HARDWARE TO PERFORM WORK. IT IS
DISTINGUISHED FROM HARDWARE BY ITS
CONCEPTUAL RATHER THAN PHYSICAL NATURE.
HARDWARE CONSISTS OF PHYSICAL
COMPONENTS, WHEREAS SOFTWARE CONSISTS
OF INSTRUCTIONS COMMUNICATED
ELECTRONICALLY TO THE HARDWARE
TWO PURPOSES

1. COMPUTERS DO NOT DIRECTLY UNDERSTAND

HUMAN LANGUAGE, AND SOFTWARE IS NEEDED TO
TRANSLATE INSTRUCTIONS CREATED IN HUMAN
LANGUAGE INTO MACHINE LANGUAGE.
2. PACKAGED, OR STORED SOFTWARE IS NEEDED TO
MAKE THE COMPUTER AN ECONOMICAL WORK
TOOL.
CATEGORIES OF SOFTWARE
1. SYSTEM SOFTWARE
2. UTILITY SOFTWARE
3. APPLICATIONS SOFTWARE
• SYSTEM SOFTWARE
IT CONSISTS OF A VARIETY OF PROGRAMS THAT
CONTROL THE INDIVIDUAL COMPUTER AND MAKE THE
USER’S APPLICATION PROGRAMS WORK WELL WITH THE
HARDWARE. SYSTEM SOFTWARE CONSISTS OF A
VARIETY OF PROGRAMS THAT INITIALIZE, OR BOOT UP,
THE COMPUTER WHEN IT IS FIRST TURNED ON AND
THEREAFTER CONTROL ALL THE FUNCTIONS OF THE
COMPUTER HARDWARE AND APPLICATIONS SOFTWARE.
SYSTEMS SOFTWARE CAN BE CATEGORIZED UNDER THE
FOLLOWING:
1. OPERATING SYSTEM (OS): HARNESSES COMMUNICATION
BETWEEN HARDWARE, SYSTEM PROGRAMS, AND OTHER
APPLICATIONS. (I.E. WINDOWS 10, IOS, ANDROID, LINUX)
2. DEVICE DRIVER: ENABLES DEVICE COMMUNICATION WITH THE OS
AND OTHER PROGRAMS
3. FIRMWARE: SET OF INSTRUCTIONS PROGRAMMED ON A
HARDWARE DEVICE. IT PROVIDES THE NECESSARY INSTRUCTIONS
FOR HOW THE DEVICE COMMUNICATES WITH THE OTHER COMPUTER
HARDWARE.
4. TRANSLATOR: TRANSLATES HIGH-LEVEL LANGUAGES TO LOW-
LEVEL MACHINE CODES
• APPLICATIONS SOFTWARE
INCLUDES ALL THE VARIOUS PROGRAMS PEOPLE
USE TO DO WORK, PROCESS DATA, PLAY GAMES,
COMMUNICATE WITH OTHERS, AND WATCH
VIDEOS AND MULTIMEDIA PROGRAMS ON A
COMPUTER. UNLIKE SYSTEM AND UTILITY
PROGRAMS, THEY ARE WRITTEN FOR SYSTEM
USERS TO MAKE USE OF THE COMPUTER. IT CAN
BE CALLED AN APPLICATION OR SIMPLY AN APP.
• UTILITY SOFTWARE
UTILITY PROGRAMS INCLUDE PROGRAMS DESIGNED TO
KEEP THE COMPUTER SYSTEM OPERATING
EFFICIENTLY. THEY DO THIS BY ADDING POWER TO THE
FUNCTIONING OF THE SYSTEM SOFTWARE OR
SUPPORTING THE OS OR APPLICATIONS SOFTWARE
PROGRAMS. UTILITY PROGRAMS HELP THE USERS IN
DISK FORMATTING, DATA COMPRESSION, DATA BACKUP,
SCANNING FOR VIRUSES ETC.
FEW EXAMPLES OF UTILITY SOFTWARE ARE:
-ANTI-VIRUS
-REGISTRY CLEANERS
-DISK DEFRAGMENTERS
-DATA BACKUP UTILITY
-DISK CLEANERS
SOFTWARE USEFUL TO NURSES
1. NCSBN LEARNING EXTENSION -MEDICATION FLASHCARDS -THIS
SIMPLE APP DOWNLOADS A MEDICATION LIBRARY TO YOUR
PHONE. GREAT FOR STUDENTS PREPARING FOR EXAMS OR
NURSES WHO NEED A QUICK REFERENCE POINT.
2. NCLEX RN MASTERY -STUDY AID -HUNDREDS OF PRACTICE
QUESTIONS AND SAMPLE QUIZZES. WHEN YOU GIVE A WRONG
ANSWER, THE APP GIVES YOU A DETAILED REASON WHY.
3. PEPID -DRUG AND CLINICAL RESOURCE -THIS APP PROVIDES
DETAILED INFORMATION
• FOR ALL ELEMENTS OF PATIENT CARE. STUDENTS GAIN A
CREDIBLE AND COMPLETE RESOURCE GUIDE FOR
COURSEWORK, LABEXERCISES, AND CLINICAL PRACTICE.
4. EPOCRATES -CLINICAL CARE ASSISTANT -THIS APP STREAMLINES
SEARCHES FOR INFORMATION ON PRESCRIPTION DRUGS, DRUG
INTERACTIONS, AND A DIRECTORY OF PROVIDERS. NURSING STUDENTS
CAN PREVENT MISTAKES ON EXAMS, AND MOST IMPORTANTLY, PROVIDE
PROPER TREATMENT WHEN THEY BEGIN PRACTICING.
5. MEDSCAPE -INFORMATIONAL RESOURCE -PUBLISHED BY WEBMD,
THIS FREE APP PROVIDES ACCESS TO A MEDICAL DIRECTORY,
CONTINUING EDUCATION, MEDICAL NEWS,AND A CLINICAL REFERENCE
LIBRARY. THE NEWS ASPECT OF THIS APP HELPS STUDENTS STAY UP TO
DATE IN THE INDUSTRY.
6. WEBMD -HEALTHCARE APP YOU NEED TO CHECK SYMPTOMS; LEARN
ABOUT CONDITIONS AND DRUGS; RESEARCH TREATMENTS AND
DIAGNOSES; FIND DOCTORS AND SPECIALISTS IN YOUR AREA; GET RX
DISCOUNTS AVAILABLE AT YOUR LOCAL PHARMACY; AND SET
MEDICATION REMINDERS.
7. MED MNEMONICS -THIS APP PROVIDES OVER 1,500
ACRONYMS, RHYMES, AND MEMORY TRICKS TO HELP
NURSES QUICKLY LEARN NUMEROUS MEDICAL
CONDITIONS, SYMPTOMS, AND OTHER MEDICAL
TERMINOLOGY.
8. TABER’S MEDICAL DICTIONARY-THE MOBILE APP
INCLUDES PHOTOS, VIDEOS, AUDIO PRONUNCIATIONS,
AND FUNCTIONALITY TO SAVE FAVORITE ENTRIES. THIS
DICTIONARY HAS 65,000 DEFINITIONS TO HELP NURSING
STUDENTS STUDY FOR TESTS.
9. NURSING CENTRAL -COMPREHENSIVE REFERENCE
RESOURCE -THE APP INCLUDES ACCESS TO DAVIS’S
DRUG GUIDE, TABER’S MEDICAL DICTIONARY, DISEASES
AND DISORDERS, AND MEDLINE SEARCH AND
JOURNALS, AMONG OTHER DATABASES.
10. NURSEGRID -THE APP LETS YOU SCHEDULE ACROSS
ALL WORKSITES, VIEW WHO’S ON YOUR SHIFT,
MESSAGE OTHER NURSES.
DATA, INFORMATION, KNOWLEDGE,
WISDOM
DATABASE
• A DATABASE IS AN ORGANIZED COLLECTION OF RELATED DATA.
• EXAMPLES ARE PAPER DATABASE AND DIGITAL RECORDS. THEY CAN
USE EACH OF THESE DATABASES TO STORE DATA AND TO SEARCH
FOR INFORMATION. THE POSSIBILITY OF FINDING INFORMATION IN
THESE DATABASES DEPENDS ON SEVERAL FACTORS.
• FOUR OF THE MOST IMPORTANT ARE THE FOLLOWING:
1. THE DATA NAMING (INDEXING) AND ORGANIZATIONAL SCHEMES
2. THE SIZE AND COMPLEXITY OF THE DATABASE
3. THE TYPE OF DATA WITHIN THE DATABASE
4. THE DATABASE SEARCH METHODOLOGY
TYPES OF DATA
• CONCEPTUAL DATA TYPES. CONCEPTUAL DATA TYPES
REFLECT HOW USERS VIEW THE DATA. THE SOURCE OF
THE DATA MAY BE THE BASIS OF CONCEPTUAL DATA
TYPES. FOR EXAMPLE, THE LAB PRODUCES LAB DATA, AND
THE X-RAY DEPARTMENT PRODUCES IMAGE DATA.
• COMPUTER-BASED DATA TYPES. ALPHANUMERIC DATA
INCLUDE LETTERS AND NUMBERS IN ANY COMBINATION;
HOWEVER, YOU CANNOT PERFORM NUMERIC
CALCULATIONS ON THE NUMBERS IN AN ALPHANUMERIC
FIELD.
• DATABASE LIFE CYCLE
THE DEVELOPMENT AND USE OF A DBMS FOLLOW A
SYSTEMATIC PROCESS CALLED THE LIFE CYCLE OF A
DATABASE SYSTEM.
1. INITIATION
2. PLANNING AND ANALYSIS
3. DETAILED SYSTEMS DESIGN AND DEVELOPMENT
4. IMPLEMENTATION
5. EVALUATION AND MAINTENANCE
1. INITIATION
• OCCURS WHEN ONE IDENTIFIES A NEED OR PROBLEM AND SEES
THE DEVELOPMENT OF A DBMS AS A POTENTIAL SOLUTION.
• WHAT IS THE NEED, WHAT DO WE WANT TO ACCOMPLISH, WHAT
ARE THE CURRENT APPROACHES, AND WHAT ARE THE
POTENTIAL OPTIONS
2. PLANNING AND ANALYSIS
• THIS STEP BEGINS WITH AN ASSESSMENT OF THE USER’S VIEW
AND THE DEVELOPMENT OF THE CONCEPTUAL MODEL AND
ENDS WITH THE LOGICAL MODEL.
• WHAT ARE THE INFORMATION NEEDS OF THE DEPARTMENT AND
HOW DOES THE DEPARTMENT USE THE INFORMATION? THIS
INCLUDES THE INTERNAL AND EXTERNAL USES OF INFORMATION.
3. DETAILED SYSTEMS DESIGN AND DEVELOPMENT
• IT BEGINS WITH THE SELECTION OF THE PHYSICAL MODEL. USING THE PHYSICAL MODEL,
IT DEVELOPS EACH TABLE AND THE RELATIONSHIPS BETWEEN THE TABLES. AT THIS
POINT, IT WILL CAREFULLY DESIGN THE DATA ENTRY SCREENS AND THE FORMAT FOR ALL
OUTPUT REPORTS.
4. IMPLEMENTATION
• IT INCLUDES TRAINING THE USERS, TESTING THE SYSTEM, FINALIZING THE PROCEDURE
MANUAL FOR USE OF THE SYSTEM, PILOTING THE DBMS, AND “GOING LIVE.”
• TRAINING USERS CAN TAKE THE FORM OF ONLINE TUTORIALS OR LIVE TRAINING AS WELL
AS ACCESS TO A HELP DESK AND/OR SUPER USERS WHO CAN PROVIDE HELP 24/7.
• TESTING THE SYSTEM IS GENERALLY DONE IN A DEVELOPMENT ENVIRONMENT WITH
SIMULATED DATA.
• THE PROCEDURE MANUAL OUTLINES THE “RULES” FOR HOW ONE USES THE SYSTEM IN
DAY-TO-DAY OPERATIONS.
5. EVALUATION AND MAINTENANCE
• INITIAL OR EARLY EVALUATIONS MAY HAVE LIMITED
VALUE. IT WILL TAKE A FEW WEEKS OR EVEN MONTHS
FOR USERS TO ADJUST THEIR WORK ROUTINES TO
THIS NEW APPROACH TO INFORMATION MANAGEMENT.
• IT IS NOT UNUSUAL FOR THERE TO BE ADJUSTMENTS
TO THE DATABASE AS WELL AS REVISIONS IN THE
PROCEDURE MANUAL DURING THIS INITIAL PERIOD OF
USE.
COMMON DATABASE OPERATIONS
• DBMSS VARY FROM SMALL PROGRAMS RUNNING ON A
PERSONAL COMPUTER TO MASSIVE PROGRAMS THAT MANAGE
THE DATA FOR LARGE INTERNATIONAL ENTERPRISES. NO
MATTER WHAT SIZE OR HOW A DBMS IS USED, THERE ARE
COMMON OPERATIONS THAT DBMSS PERFORM. THERE ARE
THREE BASIC TYPES OF DATA PROCESSING OPERATIONS.
THESE INCLUDE DATA INPUT , DATA PROCESSING , AND DATA
OUTPUT .
1. DATA INPUT OPERATIONS
• ONE USES DATA INPUT OPERATIONS TO ENTER NEW DATA, UPDATE
DATA IN THE SYSTEM, OR CHANGE/ MODIFY DATA IN THE DBMS. ONE
USUALLY ENTERS DATA THROUGH A SET OF SCREENS THAT THE
DESIGNERS HAVE DESIGNED FOR DATA ENTRY.
2. DATA PROCESSING PROCESSES
• DATA PROCESSING PROCESSES ARE DBMS-DIRECTED ACTIONS THAT
THE COMPUTER PERFORMS ON ENTERED DATA. THE PURPOSE IS TO
EXTRACT INFORMATION, DISCOVER NEW MEANINGS, REORDER DATA.
USES TO CONVERT RAW DATA INTO MEANINGFUL INFORMATION.
3. DATA OUTPUT OPERATIONS
• THESE OPERATIONS INCLUDE ONLINE AND WRITTEN REPORTS.
OUTPUT CAN ALSO INCLUDE PRESENTATION OF THE PROCESSED DATA
IN CHARTS AND GRAPHS FOR EASIER UNDERSTANDING.
INFORMATION
• A COLLECTION OF DATA WHICH CONVEYS SOME MEANINGFUL
IDEA.
• WHEN DATA IS COLLATED OR ORGANIZED INTO SOMETHING
MEANINGFUL, IT GAINS SIGNIFICANCE. THIS MEANINGFUL
ORGANIZATION IS INFORMATION.
KNOWLEDGE
• KNOWLEDGE IS THE APPROPRIATE COLLECTION OF INFORMATION.
• WHEN A STUDENT "MEMORIZES” INFORMATION, THEN HE/SHE
OBTAINED KNOWLEDGE.
• KNOWLEDGE IS AN ORGANIZATION AND PROCESSING TO CONVEY
UNDERSTANDING AND EXPERIENCE.
DATA MINING
• PROCESS OF EXTRACTING INFORMATION AND KNOWLEDGE FROM
LARGE-SCALE DATABASES AS KNOWLEDGE DISCOVERY AND DATA MINING
(KDD). THE PURPOSE OF DATA MINING IS TO FIND PREVIOUSLY UNKNOWN
PATTERNS AND TRENDS THAT WILL ASSIST IN PROVIDING QUALITY CARE,
PREDICTING BEST TREATMENT CHOICES, AND UTILIZING HEALTH
RESOURCES IN A COST-EFFECTIVE MANNER.
BENCHMARKING
• BENCHMARKING IS A PROCESS WHERE ONE COMPARES OUTCOME
MEASURES WITH INDUSTRY AVERAGES. THE PROCESS OF
BENCHMARKING MEANS TO DETERMINE THE GOAL OR OBJECTIVES,
DEFINE APPROPRIATE INDICATORS, COLLECT DATA, AND DETERMINE
RESULTS.
WISDOM
• IS SEEN AS THE POSSESSION OF KNOWLEDGE SUCH THAT
ONE IS ABLE NOT ONLY TO OBSERVE PATTERNS OF
INFORMATION WITHIN DATA AND MAKE INTELLIGENT
CONNECTIONS BETWEEN DIFFERENT PATTERNS, BUT ALSO
TO FEEL THE PRINCIPLES WHICH UNDERLIE THE PATTERNS
THEMSELVES.
• IT IS UNIQUELY A HUMAN STATE AND COMPUTERS DO NOT
HAVE AND WILL NEVER HAVE THE ABILITY TO POSSESS
WISDOM.
• IT EMBODIES PRINCIPLE, INSIGHT AND MORAL.
HEALTH DATA STANDARDS
WHY IS THERE A NEED FOR HEALTH DATA STANDARDS?
• THE ABILITY TO COMMUNICATE IN A WAY THAT ENSURES
THE MESSAGE IS RECEIVED AND THE CONTENT IS
UNDERSTOOD IS DEPENDENT ON STANDARDS.
• DATA STANDARDS ARE INTENDED TO REDUCE AMBIGUITY
IN COMMUNICATION SO THAT THE ACTIONS TAKEN BASED
ON DATA ARE CONSISTENT WITH THE ACTUAL MEANING OF
THAT DATA.
• THESE EMERGING ORGANIZATIONS ARE INVOLVED IN
STANDARDS DEVELOPMENT, COORDINATION, AND
HARMONIZATION IN ALL SECTORS OF THE ECONOMY.
SOME OF THE MAJOR NATIONAL AND INTERNATIONAL ORGANIZATIONS ARE:
1. AMERICAN NATIONAL STANDARDS INSTITUTE (ANSI)
2. EUROPEAN TECHNICAL COMMITTEE FOR STANDARDIZATION -IN 1990, TC 251
ON MEDICAL INFORMATICS WAS ESTABLISHED BY THE EUROPEAN COMMITTEE
FOR STANDARDIZATION (CEN)
3. HEALTH IT STANDARDS COMMITTEE – BY THE AMERICAN RECOVERY AND
REINVESTMENT ACT (ARRA)
4. INTEGRATING THE HEALTHCARE ENTERPRISE (IHE)
5. INTERNATIONAL ORGANIZATION FOR STANDARDIZATION (ISO)
6. OBJECT MANAGEMENT GROUP –WHILE THE ORGANIZATIONS DESCRIBED
THUS FAR ARE MADE UP OF VOLUNTEER-BASED SDOS, THE OBJECT
MANAGEMENT GROUP (OMG)
7. PUBLIC HEALTH DATA STANDARDS CONSORTIUM (PHDSC)
HUMAN-COMPUTER
INTERACTION
BRIEF HISTORY OF HCI
• BEFORE COMPUTERS
• FACTORIES, MASS PRODUCING DIFFERENT PRODUCTS, FELT THE NEED
THAT HOW THEIR WORKERS PERFORMED, I.E. THEIR EFFICIENCY, DURING
WORK WILL AFFECT THEIR YIELD. THESE STUDIES STARTED ALREADY
LAST CENTURY.
• WORLD WAR II ALSO TOOK INTEREST IN BUILDING MORE EFFECTIVE
WEAPONS. THIS LED TO THE STUDY OF HOW MACHINES AND HUMAN
INTERACT TO INCREASE EFFICIENCY AND EFFECTIVENESS
• THE ERGONOMICS RESEARCH SOCIETY WAS ESTABLISHED IN 1949 AND
THEY FOCUSED ON PHYSICAL CHARACTERISTICS OF MACHINES AND
SYSTEMS AND HOW THESE AFFECT HUMAN PERFORMANCE.
• DAWN OF PERSONAL COMPUTING
• COMPUTERS BECAME MORE COMMON, AND THIS LED TO
RESEARCHERS SPECIALIZING IN INTERACTIONS BETWEEN
COMPUTERS AND PEOPLE. THE MASSES WANTED COMPUTING
AND THEY DIDN’T WANT TO GO THROUGH COMPLICATED
RIGMAROLE TO DO WHAT THEY WANTED WITH A COMPUTER.
THEY WANT SIMPLE USE AND ACCESS TO COMPUTERS.
• HCI EMERGES
• THE TERM HCI BECAME POPULAR IN THE 1980S.
• JOHN MILLAR CARROLL, AN AMERICAN DISTINGUISHED
PROFESSOR OF INFORMATION SCIENCES AND TECHNOLOGY
AT PENNSYLVANIA STAE UNIVERSITY, WHERE HE PREVIOUSLY
SERVED AS THE EDWARD FRYMOYER CHAIR OF INFORMATION
SCIENCES AND TECHNOLOGY SAYS THAT THE DISCIPLINE OF
HUMAN COMPUTER INTERACTION WAS BORN IN 1980 AS ALL
THESE SEPARATE DISCIPLINES BEGAN TO REALIGN AROUND A
SINGLE OBJECTIVE; MAKING COMPUTING EASIER FOR THE
MASSES.
HCI, OR HUMAN-COMPUTER
INTERACTION
• IS A SPECIALIZED FIELD OF
STUDY CONCERNED WITH THE
INTERACTION BETWEEN
PEOPLE (USERS) AND
COMPUTERS. THIS FIELD IS
MULTI-DISCIPLINARY. THESE
INCLUDE COMPUTER SCIENCE,
COGNITIVE SCIENCE, HUMAN
FACTORS, AMONG OTHERS.
INFORMATICS IN HEALTHCARE
INFORMATICS IN NURSING PRACTICE
• THE ROLE OF THE 21ST NURSE IS COMPLEX, REQUIRING
INTERACTION WITH MULTIPLE MEDICAL DEVICES AND
HEALTH IT.
• NURSES AT ALL LEVELS OF EDUCATION PREPARATION AND
IN ALL HEALTHCARE SETTINGS USE TECHNOLOGY EVERY
DAY IN PRACTICE.
• IN ADDITION TO BECOMING EXPERT USERS, IT IS
INCREASINGLY LIKELY THAT NURSES, BECAUSE OF THEIR
EXPERIENCE IN PATIENT CARE, WILL BE CALLED ON TO
PARTICIPATE IN THE DESIGN OF NEW CLINICAL SYSTEMS
FOR DELIVERING HIGH-QUALITY AND EFFICIENT CARE.
MEDICAL SOFTWARE
• ALSO KNOWN AS HEALTH INFORMATION TECHNOLOGY
SOFTWARE.
• A BLANKET CATEGORY THAT INCLUDES SEVERAL DIFFERENT
SOFTWARE TYPES.
• A CATEGORY OF TOOLS USED IN MEDICAL SETTINGS THAT
COLLECT DATA POINTS ON INDIVIDUAL PATIENT HEALTH FOR
FUTURE REFERENCE, LONG-TERM STUDY OF BEHAVIORS, OR
SHORT-TERM DIAGNOSES.
• THE TOOLS CAN BE FOUND IN ALL SECTORS OF THE
HEALTHCARE AND MEDICAL INDUSTRIES, FROM PHARMACIES
AND LABS TO MENTAL HEALTH AND PHYSICAL REHABILITATION
FACILITIES.
• ANY SOFTWARE ITEM OR SYSTEM USED WITHIN A MEDICAL CONTEXT, SUCH
AS:
1. STANDALONE SOFTWARE USED FOR DIAGNOSTIC OR THERAPEUTIC
PURPOSES
2. SOFTWARE EMBEDDED IN A MEDICAL DEVICE (OFTEN REFERRED TO AS
“MEDICAL DEVICE SOFTWARE”)
3. SOFTWARE THAT ACTS AS AN ACCESSORY TO A MEDICAL DEVICE
4. SOFTWARE USED IN THE DESIGN, PRODUCTION, AND TESTING OF A
MEDICAL DEVICE
5. SOFTWARE THAT PROVIDES QUALITY CONTROL MANAGEMENT OF A
MEDICAL DEVICE.
• THESE TOOLS OFTEN INCLUDE MEDICAL RECORDS, CHARTING, BILLING,
SUPPLY MANAGEMENT, AND RESOURCE ALLOCATION SOFTWARE.
WEARABLE MEDICAL DEVICES
• STORES VITAL SIGNS, AGGREGATE HEALTH DATA
POINTS ACROSS LONG PERIODS OF TIME, AND CAN BE
USED IN CONJUNCTION WITH RECORDS TOOLS TO
IMPROVE PATIENT CARE AND ENGAGEMENT.
COMPUTERS IN NURSING
• COMPUTERS CAN PERFORM A WIDE RANGE OF
ACTIVITIES THAT SAVE TIME AND HELP NURSES
PROVIDE QUALITY NURSING CARE

• NURSING PRACTICE
• COMPUTER SYSTEMS, PATIENT CARE DATA AND NCP’S
ARE INTEGRATED TO ELECTRONIC HEALTH RECORD
FUNCTIONS
• RECORDS CLIENT INFORMATION
• PROVIDES ACCESS TO OTHER DEPARTMENTS
• USED TO MANAGE CLIENT SCHEDULING
DOCUMENTATION OF CLIENT STATUS AND MEDICAL
RECORDS KEEPING
• PROVIDES ACCESS TO STANDARDIZED FORMS, POLICIES
AND PROCEDURES
• ACCESS DATA ABOUT CLIENT THAT MAY BE SOMEWHERE IN
THE MEDICAL RECORD OR ELSEWHERE IN HEALTH CARE
AGENCY
BEDSIDE DATA ENTRY
• RECORDS CLIENTS ASSESSMENTS, MEDICATION
ADMINISTRATION, PROGRESS NOTES, CARE PLAN
UPDATING, CLIENT ACUITY AND ACCRUED CHANGES
COMPUTER BASED CLIENT RECORD
• EMRS/CPRS
○ PROVIDES EASY RETRIEVAL OF SPECIFIC DATA SUCH
AS TRENDS IN VITAL SIGNS, IMMUNIZATION RECORDS,
CURRENT PROBLEMS
○ IT CAN BE DESIGNED TO WORK PROVIDERS ABOUT
CONFLICTING MEDICATIONS OR CLIENT PARAMETERS
THAT INDICATE DANGEROUS CONDITIONS
ELECTRONIC ACCESS TO CLIENTS
• USED EXTENSIVELY IN HEALTH CARE TO ASSESS AND
MONITOR CLIENTS CONDITIONS● DATA ACCUMULATED
FROM VARIOUS ELECTRONIC DEVICES ARE STORED
FOR RESEARCH PURPOSES
• CAN MONITOR CLIENT
• COMPUTERIZED DIAGNOSIS
• TELEMEDICINE
PRACTICE MANAGEMENT
• USED TO ORDER SUPPLIES, TESTS, MEALS, AND SERVICES, FROM OTHER DEPARTMENTS
• ALLOWS NURSING SERVICE TO DETERMINE THE MOST COSTLY ITEMS USED BY A PARTICULAR
NURSING UNIT
• MAY PROVIDE INFORMATION OR DECISIONS TO MODIFY BUDGET, PROVIDE DIFFERENT STAFFING,
MOVE SUPPLIES TO DIFFERENT LOCATIONS, OR MAKE OTHER CHANGES FOR MORE EFFICIENT
AND HIGHER QUALITY CARE
• ALL RELEVANT STAKEHOLDERS ARE LINKED TOGETHER
• ENABLES AMBULANCE STAFF TO MONITOR DIAGNOSE AND TREAT PATIENT AS WELL AS UTILIZING
DECISION SUPPORT LIKE GUIDELINES, CHECKLISTS AND SECOND OPINION/TELEMEDICINE
• DOCUMENTATION USING THE INTEGRATED EPR
• ENABLES HOSPITAL STAFF TO GUIDE, ASSIST AND PREPARE THE MEDICAL CARE USING
CONTINUOUSLY TRANSMITTED VITAL SIGNS, CHAT, EPR AND OTHER INFORMATION E.G.
CHECKLISTS
• FACILITATING AND SUPPORTING A BORDERLESS “TEAM” APPROACH TO PRE-HOSPITAL CARE
• ENABLES INTEGRATION OF PRE-HOSPITAL CARE IN PATIENT CENTRIC CLINICAL PATHWAYS AND
PROCESSES
• BENEFITS OF COMPUTER AUTOMATION IN HEALTH
CARE:
• MANY OF THESE BENEFITS HAVE CAME ABOUT WITH
THE DEVELOPMENT OF ELECTRONIC MEDICAL
RECORD (EMR), WHICH IS THE ELECTRONIC VERSION
OF THE CLIENT DATA FOUND IN THE TRADITIONAL
PAPER RECORD.
EMR BENEFITS INCLUDE:
• IMPROVED ACCESS TO THE MEDICAL RECORD○ THE EMR
CAN BE ACCESSED FROM SEVERAL DIFFERENT
LOCATIONS SIMULTANEOUSLY, AS WELL AS BY DIFFERENT
LEVELS OF PROVIDERS.
• DECREASED REDUNDANCY OF DATA ENTRY
○ FOR EXAMPLE, ALLERGIES AND VITAL SIGNS NEED ONLY
BE ENTERED ONCE.
• DECREASED TIME SPENT IN DOCUMENTATION
• AUTOMATION ALLOWS DIRECT ENTRY FROM MONITORING
EQUIPMENT, AS WELL AS POINT-OF-CARE DATA ENTRY.
• INCREASED TIME FOR CLIENT CARE
○ MORE TIME IS AVAILABLE FOR CLIENT CARE BECAUSE LESS TIME
IS REQUIRED FOR DOCUMENTATION AND TRANSCRIPTION OF
PHYSICIAN ORDERS.
• FACILITATION OF DATA COLLECTION FOR RESEARCH
○ ELECTRONICALLY STORED CLIENT RECORDS PROVIDE QUICK
ACCESS TO CLINICAL DATA FOR A LARGE NUMBER OF CLIENTS.
• IMPROVED COMMUNICATION AND DECREASED POTENTIAL FOR
ERROR
○ IMPROVED LEGIBILITY OF CLINICIAN DOCUMENTATION AND
ORDERS IS SEEN WITH COMPUTERIZED INFORMATION SYSTEMS.
• CREATION OF A LIFETIME CLINICAL RECORD FACILITATED BY
INFORMATION SYSTEMS
• BENEFITS OF AUTOMATION AND COMPUTERIZATION ARE RELATED TO THE
USE OF DECISION-SUPPORT SOFTWARE, COMPUTER SOFTWARE PROGRAMS
THAT ORGANIZE INFORMATION TO AID IN DECISION MAKING FOR CLIENT
CARE OR ADMINISTRATIVE ISSUES; THESE INCLUDE:
○ DECISION-SUPPORT TOOLS AS WELL AS ALERTS AND REMINDERS NOTIFY
CLINICIAN OF POSSIBLE CONCERNS OR OMISSIONS.
○ EFFECTIVE DATA MANAGEMENT AND TREND-FINDING INCLUDE THE ABILITY
TO PROVIDE HISTORICAL OR CURRENT DATA REPORTS.
○ EXTENSIVE FINANCIAL INFORMATION CAN BE COLLECTED AND ANALYZED
FOR TRENDS. AN EXTREMELY IMPORTANT BENEFIT IN THIS ERA OF MANAGED
CARE AND COST CUTTING.
○ DATA RELATED TO TREATMENT SUCH AS INPATIENT LENGTH OF STAY AND
THE LOWEST LEVEL OF CARE PROVIDER REQUIRED CAN BE USED TO
DECREASE COSTS.
NURSING INFORMATICS SPECIALIST
• BECAUSE OF THE INCREASED IMPORTANCE OF
COMPUTERS AND INFORMATION TECHNOLOGY IN THE
PRACTICE OF PROFESSIONAL NURSING; A NEW ROLE
HAS EMERGED, THE NURSING INFORMATICS
SPECIALISTS (NIS).
• THE NIS IS A NURSE WHO HAS FORMAL EDUCATION,
CERTIFICATION AND PRACTICAL EXPERIENCE IN USING
COMPUTERS IN PATIENT CARE SETTINGS.
COMPUTER HEALTH APPLICATIONS
COMMUNITY HEALTH NURSING (CHN)
• IS A SYNTHESIS OF NURSING PRACTICE AND PUBLIC HEALTH
PRACTICE APPLIED TO PROMOTING AND PRESERVING THE HEALTH OF
THE POPULATIONS.
• THE SCOPE IS NOT LIMITED TO PARTICULAR AGE, DIAGNOSTIC GROUP
OR PRACTICE SETTINGS.
• IT REQUIRES A COMPREHENSIVE UNDERSTANDING AND KNOWLEDGE
OF THE FRAMEWORK OF THE COMMUNITY, ITS RESOURCES, AND THE
SOCIO-CULTURAL ISSUES IMPACTING PEOPLE WITHIN THE
COMMUNITY.
• THE STANDARDS OF CHN INCORPORATE HEALTH PROMOTION, HEALTH
MAINTENANCE, HEALTH EDUCATION, HEALTH MANAGEMENT,
COORDINATION, AND CONTINUITY OF CARE USING A HOLISTIC
APPROACH.
• COMPUTER SYSTEMS AND OR APPLICATIONS FOR CHN
HAVE BEEN DEVELOPED TO SUPPORT CLINICAL PRACTICE
AND BECAUSE OF ITS BROAD SCOPE OF SERVICES THERE
IS A WIDE VARIANCE IN APPLICATIONS.
• APPLICATION EXAMPLES: POPULATION FOCUSED
(TRACKING CHILDHOOD IMMUNIZATION RATES IN A HEALTH
DEPARTMENT), CONTINUITY OF CARE NEEDS (PATIENT
HOSPITAL DATA AVAILABLE IN AN OUTPATIENT SETTING
FOR SPECIFIC DIAGNOSTIC GROUP), AND OR BILLING OF
SERVICES (POINT OF CARE SYSTEM FOR DOCUMENTING
HOME HEALTH CARE ASSESSMENT TO CREATE A HOME
HEALTH RELATED GROUP {HHRG} FOR EPISODIC PAYMENT
AMBULATORY CARE SYSTEMS
• APPLICATIONS NECESSARY: SIMILAR TO IN – PATIENT
ARENA. REGISTRATION, BILLING, ACCOUNTS
RECEIVABLE, ACCOUNTS PAYABLE, PATIENT AND STAFF
SCHEDULING, AND MANAGED CARE FUNCTIONALITY.
• BENEFITS THAT CAN BE ACHIEVED USING ELECTRONIC
RECORDS ENCOMPASS FINANCIAL, ADMINISTRATIVE
AND CLINICAL AREAS.