NURSING INFORMATICS Dr. Ali M. Hadianfard Faculty member of AJUMS

Further reading Nursing Informatics Where Technology and Caring, Marion J. Ball, Biomedical Informatics-Computer Applications in Health Care and Biomedicine, Edward H. Shortliffe, James J. Cimino, 3rd Ed., 2006 (chapter 17).

What is nursing informatics? Nursing Informatics is the "science and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide” (IMIA, 2009). 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 and knowledge to support patients, nurses and other providers in their decision-making in all roles and settings. The goal of nursing informatics is to design and implement systems that improve documentation accuracy, eliminate unnecessary work, enhance accuracy and enable analysis of clinical data. Informatics is no longer an option for nurses and other health care providers. It is a requirement.

How do Informatics Nurses Impact the Nursing Process? o Communicate & coordinate care with all other clinical disciplines o Coordinate discharge planning, education & teaching, transitions of care o Manage all information related to the nursing process and patient care delivery Because informatics is integrated into nursing practice. They are now additional steps in the nursing process.

TIGER Technology Informatics Guiding Educational Reform (TIGER; Initiative is a major resource for nursing informatics competencies. The purpose of TIGER is to integrate informatics to the practice of every nurse. The TIGER was formed in 2004 to bring together nursing stakeholders to develop a shared vision, strategies, and specific actions for improving nursing practice, education, and the delivery of patient care through the use of health information technology (IT). In 2006, the TIGER Initiative convened a summit of nursing stakeholders to develop, publish, and commit to carrying out the action steps defined within this plan. The Summary Report titled Evidence and Informatics Transforming Nursing: 3-Year Action Steps toward a 10-Year Vision. The TIGER Allows informatics tools, principles, theories and practices to be used by nurses to make healthcare safer, effective, efficient, patient-centered, timely and equitable.

Point of Care (POC) systems POC include services provided to patients at the bedside such as diagnostic and laboratory testing using automated information entry systems. Clinicians want a product that can help them do everything they need to do at the point of care. Smart POC systems have key attributes, namely: They anticipate your needs – have data/information you need before you need it They understand your context-dependent workflows They wait on you They hide all the complexity of underlying health IT systems with simplicity (“magical” IT) They are built to bring immediate value to you

The Smart POC system is designed to: -Automatically present relevant clinical data and information via prefilled “Clinical Widgets” -Offer “Executable” patient care plans -Unobtrusively collect patient data -Generate relevant charge or billing information as a by-product -Adapt to the nurse’s and communities’ best practices

Benefits of the Point-of-Care (POC) Model -Improvements in data completeness and accuracy, and timeliness of reports -Clinical decision support -Encoding of clinical protocols and guidelines in the system -Improvements in efficiency -Immediate availability of information in the system to the healthcare practitioners while managing the patient -Supporting a team-based approach to patient management -Clinical calculation -Noninvasive methods: The recent trend has been to design noninvasive methods. Much of development of noninvasive technology can be attributed to the availability of microcomputers and solid-state sensors.

Using computer in Point of Care ICU units use computer almost universally for the following purposes: -To acquire physiological data frequently or continuously, such as blood pressure readings -To communicate information from data-producing systems to remote locations (e.g., laboratory and radiology departments) -To store, organize, and report data -To integrate and correlate data from multiple sources -To provide clinical alerts and advisories based on multiple sources of data -To function as a decision-making tool that health professionals may use in planning the care of critically ill patients -To measure the severity of illness for patient classification purposes -To analyze the outcomes of ICU care in terms of clinical effectiveness and cost effectiveness

Point of Care Laboratory Testing Many laboratory tests, including pH, PO2, PCO2, HCO3, electrolytes, glucose, ionized calcium, other chemistries, hemoglobin, and hematocrit, can be performed in 2 minutes using two or three drops of blood. Results are displayed on the bedside physiological monitor and are stored in the monitor’s database for comparison with previous results. These laboratory results obtained at the bedside are also automatically transmitted through the monitoring network and hospital’s backbone network to the laboratory computer system, and other systems as required, so that the results can be integrated into the patient’s long-term records.

Automated data capture from bedside medical devices is now possible using the IEEE MIB 1073 communications standards (the Institute of Electrical and Electronics Engineers Medical Information Bus P1073 standard). With these standards in place, it is possible for vendors and hospitals to implement “plug and play” interfaces to a wide variety of bedside medical devices such as bedside monitors, IV pumps, and ventilators.