COMPUTERS AND NURSING

Dr. Shirley E. MarananProfessor

Some barriers are:

• Initial cost of acquisition• Privacy and security• Clinician resistance• Integration of legacy systems: this possess a

stiff challenge to many organizations

Some of the benefits are:

• Easy access of patient data• Structured information• Improved drug prescription and patient

safety: Clinical Information Systems improved drug dosing and this leads to the reduction of adverse drug interactions while promoting more appropriate pharmaceutical utilization.

HISTORICAL PERSPECTIVE OF NURSING AND COMPUTER

Major historical perspectives of nursing and computers

• Six time periods• Four major nursing areas• Standard initiatives• Significant land mark events (chart)

Nursing Practice

• Computer systems, patient care data and NPC’s are integrated to Electronic Health Record.

• Need for HER was perceived• New Nursing terminologies were recognized.

Nursing Administration

• Computers linked department together.• Hospitals data are accessed through

computers.• Hospitals process goes online• Internet was utiilized.

Nursing Education

• Most nursing schools offered computer enhanced coursed.

• Campus-wide computer systems became available.

• Computer technology integrated into teaching methodologies.

• World Wide Web facilitates student-centered instructional settings.

Nursing Research

• Provides an avenue for analyzing data• Softwares are available for processing

qualitative and quantitative data• Research databases emerged• Online access

Standard Initiative

• Nursing practice• Nursing data• Health care data standards

Nursing practice standard

• American Nurses Association (ANA) – considered an official nursing organization that contributes in the development and recommendation of standards of nursing practice worldwide.

• Joint Commission on Accreditation of Hospital Organizations (JCAHO) – focuses on the need for adequate records on patient in hospital and practice of standards in documentation of care.

Nursing data standard

• Emerged as a new requirements for EHR• 13 nursing terminologies that has been

recognized by ANA• Critical care classification system• Nursing information classification

Health care data standards organizations

• It is a critical review for the standard organizations that have emerged to either develop or recommend health care data standards that should be recommended to the federal government as required health care data standards.

Significant Landmark of Event

• 1961 – Healthcare Information and Management Systems Society was founded.

• 1965 – Development of one of the first hospital information system in California.

• 1973 – First Conference on Management Information System

• 1977 - First research: state-of-the-art conference on Nursing Information Systems (NIS) held in Chicago 1979 First military conference on computers in nursing in Washington DC 1980 First workshop on computer usage in healthcare sponsored by the University of Akron Ohio Significant Landmark Event YEAREVENT

• 1981 – First National Conference on Computer Technology held in Bethesda becoming an annual event, held in Newark, New Jersey First international meeting: Working Conference on Nursing Uses and Computers in Nursing held in London First workshop on computers in nursing held in Boston.

• 1984 – First Nursing Computer Journal is published

• 1989 – Graduate program in Nursing Informatics was introduced in Maryland University

• 1991 International Classification of Nursing Practice (ICNP) was initiated First Doctoral Specialty in Nursing Informatics sponsored by Maryland University

• 1992 American Nursing Informatics Association is initiated at California, has since become international ANA recognizes taxonomies: HHCC, OMAHA, NANDA, NIC ANA recognizes Nursing Informatics as a specialty by delineating the scope of practice

• 1993 – first International Nursing Informatics Teleconference held in Australia.

• 1996 First Harriet Werley Award for best nursing informatics paper Online Journal of Nursing Informatics (OJNI) first published

• 1997 Nursing Information and Data Set Evaluation Center (NIDSEC) standards and scoring guidelines published to address documentation of nursing care

• 1999 Nursing Vocabulary Summit Conference Held

• 2002 – JCAHO identified clinical information system as a way to improve safety and recommends that hospitals adopt technology.

• 2003 – Health Insurance Portability and Accountability Act

• 2004 – Establishment of the National Health Information Coordinator.

ELECTRONIC HEALTH RECORD FROM A HISTORICAL PERSPECTIVE

Introduction

• An electronic record composed of health information regarding an individual patient that exists as part of a complete system designed to provide access to, and management of, such information. The EHR is developed and managed by the health facility or provider. The term Electronic Health Record has largely replaced the older “Electronic Medical Record.”

• It is much more than an electronic replacement of existing paper systems. The EHR can start to actively support clinical care by providing a wide variety of information services. However, it is hard to understand what information is really important to clinical care and what is simply occasionally desirable.

• The EHR bring uncountable advantages in primary health care detaching such as the faster access to information, the updated information, it allows having a clinical process with all the patient clinical information and an easier access to information (ex: allows the simultaneous access from different locations).

• Recognizable efforts in the development of EHR are distinguished by the Nicholas E. Davis Awards of Excellence Program whose history describes the improvement of EHR in different settings

The Nicholas E. Davies Awards of Excellence Program

• The Computer-Based Patient Record Institute (CPRI), founded in 1992, was an organization representing all the stakeholders in healthcare, focusing on the clinical applications of information technology. It was among the first nationally based organizations to initiate and coordinate activities to facilitate and promote the routine use of Computer-Based Patient Records (CPRs) throughout healthcare. The Nicholas E. Davies Awards of Excellence Program

• The CPRI group on CPR Systems Evaluation developed the CPR project evaluation criteria in 1993 which became the basis in assessing accomplishments of CPR projects and provided the Foundation of Nicholas E. Davies Awards Excellence Program

• The Program was named after Dr. Nicholas E. Davis, an Atlanta-based physician, president elect of the American College of Physicians, and member of Institute of Medicine (IOM) committee in improving patient records. He was killed in a plane crash just as the IOM report on CPRs was being released

Differences of Nicholas E. Davis Excellence Awardees

• On the other hand, Nicholas E. Davis Excellence awardees shows differences that make one distinct from the other Variable years spent in EHR program development. Different external agenda and societal challenges. Application of new technologies and techniques. Differences of Nicholas E. Davis Excellence Awardees

• The HIMSS Nicholas E. Davies Awards of Excellence recognize excellence in the implementation and use of health information technology, specifically EHRs, for healthcare organizations, private practices and public health systems

• Nowadays the Nicholas E. Davies Awards Excellence Program is managed by the Healthcare Information Management Systems Society , and has the following program.

Objective• Promote the vision of EHR systems through

concrete examples Understand and share documented value of EHR systems

• Provide visibility and recognition for high impact EHR system

• Share successful EHR implementation strategies• Encourages and recognizes excellence in the

implementation of EMREHR systems: Implementation, Strategy, Planning, Project Management and Governance– Strategy Objectives:

The Healthcare Information Management Systems Society

(HIMSS)• The Healthcare Information and Management

Systems Society (HIMSS) is the healthcare industry's membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare.

HIMMS Vision

• Advancing the best use of information and management systems for the betterment of health care HIMMS Mission - To lead change in the healthcare information and management systems field through knowledge sharing, advocacy, collaboration, innovation, and community affiliations HIMMS

Four Criteria• Management - the organizational aspects of EHR

implementation; strategy, planning, project management and governance

• Functionality - delivered by the EHR to meet the organizational objectives and the needs of patients and end-users

• Technology - technical design and architecture that enable the EHR to deliver the required functionality and performance

• Value - concrete return on investment as well as intrinsic value derived from the implementation of the EHR

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