NI day 3 2012

Part 1 – CInformatics

Theory

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Is a science that combines domain sciences, computer science, information science and cognitive science; thus it is a MULTIDISCIPLINARY SCIENCE from varied theories and knowledge;

Healthcare informatics is the integration of healthcare sciences, computer science, information science and cognitive science to assist in the management of healthcare information

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Medical informatics is the preferred term for Healthcare informatics;

Informatics used in educating healthcare clients and/or the general public;

It addresses the study and management of healthcare information

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Is the use of information technologies in relation to any nursing functions and actions of nurses (Hannah, 1985);

Is a combination of computer science, information science and nursing science designed to assist in the management and processing of nursing data, information and knowledge to support the practice of nursing and the delivery of nursing care (Graves & Concoran, 1989)

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As the specialty that integrates nursing science, computer science, and information science in identifying, collecting, processing, and managing data information to support nursing practice, administration, education, research and the expansion of nursing knowledge (ANA, 1994)

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Is a specialty that integrates nursing science, computer science and information science to manage and communicate data, information, and knowledge to nursing practice…it facilitates the integration of data, information and knowledge 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, 2001b)

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Data, information and knowledge as METASTRUCTURES or OVERARCHING concepts for nursing informatics;

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Data

Information

Knowledge

Human intellect

Co

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lex

ity

– discrete entities that are described

objectively without interpretation and may

have value assigned to a variable

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- reflects interpretation, organization or structuring of data;

- the result of processing data; data processing occurs when raw facts are transformed through the application of context to give meaning via organization of data into a structure that connotes meaning

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- Emerges from transformation of information;- It is information that is synthesized so that

relationships are identified and formalized;- Note processing of information don’t always

result to knowledge

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Twenty-first century knowledge workers Skills (assessment, planning, critical thinking

and evaluation) are transferable to many different settings

Depends on access to data, information and knowledge

Data captured at the source in the course of clinical care are very useful

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Data are utilized to track effectiveness of nursing decisions;

Analysis, combination, aggregations and summarization are ways in which an information system can transform data to information and then to knowledge

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Evolution from NOVICE to EXPERT which a nurse must continually exhibit the capability to acquire and demonstrate specific skills;

Increased proficiency over time results to enhanced competencies reflecting mastery and ability to cope with and manage contingencies

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Continued practice, combined with additional professional experience and knowledge; allows the nurse to evolve to the proficient level of appreciating the rules and maxims of practice;

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Data sets comprised of data elements brought together for a specific reason “ for storing data in a way that maintains the logical relationships among data elements, and are stored in a computer;

Logical structure of data base is determined by the conceptual or theoretical views held by the database developer

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NANDA-I

Nursing Interventions Classification (NIC)

Nursing Outcomes Classification (NOC)

Clinical Care Classification (CCC)

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OMAHA System

SNOMED CT Patient Care Data Set (PCDS)

Logical Observation Identifiers Names and Codes (LOINC)

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International Classification for Nursing Practice (ICNP)

Nursing Management Minimum Data Set (NMMDS)

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Vocabulary Problem◦ the development of multiple specialized

terminologies causing overlapping content, and large number of codes;◦ terminologies develop pertaining to set s of terms,

definitions and concepts for human interpretation;◦ Knowledge understandable to human is confusing

for computers;◦ Inadequate terminologies to meet data needs

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The health informatics literature provides an evolving framework that enumerates the criteria that render healthcare terminologies suitable for implementation in computer-based systems;

Such terminologies must be concept-oriented, rather than based on surface linguistics

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Nursing Minimum Data Set (NMDA) focused on the extensive development and refinement of terminologies;

for describing patient problems, nursing interventions and nursing-sensitive patient outcomes and the development of International Classification for Nursing Practice

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The main component of advanced terminology systems:◦ is a concept-oriented terminology model;

◦ ontology representing a set of concepts and their interrelationships;

◦ a model using an ontology language that may be implemented using description logic within a software system.

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Is a concept-based representation of a collection of domain-specific terms that is optimized for the management of terminological definitions;

It encompasses both schemata and type definition e.g. “dyspnea/ severe dyspnea”

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Represent classes/ concepts/ categories/ types/ properties;

Ontological language is able to support, through explicit semantics the formal definition of concepts in terms of their relationships with other concepts;

It facilitates reasoning, whether 2 concepts are equivalent or not e.g. “pain, acute pain”

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A representation language may be implemented using description logic within a software system or by a suite of software tools.

The functionality of these tools varies but may include other things management and internal organization of model, reasoning on the model.

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ISO 18104:2003 ◦ An international standard covering reference

terminology models for nursing diagnoses and nursing actions; approved in 2003;

◦ Was developed ISO Technical Committee in collaboration with the International Medical Informatics Association;

◦ Originated within European Committee fro standardization

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GALEN

◦ A concept-oriented approach developed within the GALEN program;

◦ GALEN is used in a range of ways, from directly supporting clinical applications to support the authoring, maintenance and quality assurance of other kinds of terminologies.

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SNOMED RT- An alternative concept-oriented approach was

developed between College of American pahologies and Keiser Permanente;

- It is a reference terminology optimized for clinical data retrieval and analysis;

- Concepts and relationships are represented using modified KRSS rather than GRAIL;

- Functionality includes:- 1. acronym resolution, word completion, term completion, spelling, display of authorized form- 2. automated classification- 3. conflict management

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CIS, assists clinicians with data necessary for decision-making and problem solving;

clinical disciplines and specialty services share common user requirements as well as having specialized practice requirements;

just as multiple departments work in a concert for optimum patient care delivery, the components of a CIS coordinated fashion

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Regardless of size/type of system CIS must complete the 8 phases of implementation;

The implementation of clinical information is a process introducing an application or information system to an organization, ensuring the full benefits and potential of the system are realized;

The phases of implementation use a problem-solving, scientific approach;

The problem-solving begins with observation of the operations or problem in question.

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The 2nd step requires an in-depth assessment of the issues,

3rd step developing and 4th step implementing a plan to resolve the problem;

Last step evaluation – provides feedback

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Planning System analysis System design/system selection Development Testing Training Implementation Evaluation

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The project begins when the organization determines that an existing need/problem must be solved by the CIS application;

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The ACTIVE INVOLVEMENT of the nurse executive is vital for

SUCCESS

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is the fact-finding phase; all data requirements elated to the problem defined are collected and analyzed to gain sound understanding of the current system, how it is used, what is needed for the new system

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Data flowchart

Grid chart

Decision table

Organizational chart

Model

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Details of the system and the detailed plans for implementing the system are developed for both the functional and the technical components of the system;

Acceptance of the system proposal by the steering committee heralds the beginning of the system design.

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Newly developed system are assessed to ensure that all data are processed correctly and the desired outputs are generated;

It verifies that the computer programs are written correctly and ensures that when implemented in the production environment the system will function as planned

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It is the preparation of all documents to described the system for all users is an ongoing activity, with development of the documentation occurring as the various system phases and steps are completed;

It includes: User’s manual, Reference manual and Operator’s maintenance manual

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Prepare the end users on how to use the system properly;

2 Levels of Training:◦ The project team and selected members of the

system◦ End-user training

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Organizes all the steps into a detailed plan describing the series of events required to begin using the system or application in the production or live environment;

Details the necessary computer and software maintenance operations required to keep the system running.

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Describes and assesses in detail the new system’s performance;

It summarizes the entire systems, identifying both the strengths and weaknesses of the implementation process;

It determines if the system accomplished the stated objectives.

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Bedside/point-of-care wireless devices Workstations Multimedia presentations Decision support Artificial intelligence Neural networks Open architecture

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The mode to gain access to multiple applications;

The user has broad array of access to information;

Systems running side-by-side, redundant pathways and vendor and platform independence

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