THE PRACTICE SPECIALTY OF NURSING INFORMATICS

Informatics - a science that combines a domain science, computer

science, information science, and cognitive science. Thus, it is a
multidisciplinary science drawing from varied theories and knowledge
applications.

Healthcare Informatics - may be defined as “the integration of

healthcare sciences, computer science, information science, and
cognitive science to assist in the management of healthcare
information” (Saba & McCormick, 2015, p. 232). It is a subset of NI AS A SPECIALTY
informatics, as is nursing informatics. It addresses the study and
management of healthcare information. - 1992: ANA recognized nursing informatics as a specialty in nursing
with a distinct body of knowledge and distinct scope of practice
HEALTHCARE INFORMATICS
● Electronic Health Record (EHR) ● - includes a differentiated practice, a well-derived
knowledge base, a defined research program,
System Life Cycle (SLC): subcomponent of project organizational representation, educational programs, and
management, evaluation, Human–Computer Interaction (HCI) a credentialing mechanism

Telehealth
● Healthcare information systems, imaging, knowledge ● focuses on the information of nursing needed to address
representation, education, and information retrieval these core phenomena: data, information, knowledge,
and wisdom
Informatics Nurse (IN) ● is represented in international, national, regional, and
● - a registered nurse who has an interest or experience in local organizations
nursing informatics. ● part of the clinical section of the Healthcare Information
and Management Systems Society (HIMSS)
Informatics Nurse Specialists (INSs) - - 1989: University of Maryland established the first graduate program
● are registered nurses prepared at the graduate level in nursing informatics. The University of Utah followed in 1990
(master’s degree or higher) in nursing informatics,
informatics, or an informatics_x0002_related field Certifications that Support the NI Specialty

Nursing Informatics ● American Nurses Credentialing Center (ANCC) established a

● - as a subset of healthcare informatics, shares common certification process and examination
● Information for the HIMSS Certified Professional in Health
areas of science with other health professions and,
Information and Management Systems (CPHIMS) and Certified
therefore, easily supports interprofessional education, Associate in Health Information and Management Systems
practice, and research focused on healthcare informatics (CAHIMS) certifications
● - includes components such as standardized nursing ● Project manager is the Project Management Professional (PMP)
terminologies, that address the special information needs ● Nurse Educator–Certified Nurse Educator (CNE)
for the nursing profession and healthcare consumers ● The Certified E-Discovery Specialist (CEDS) Certification
● - reflects this duality as well, moving through the
continuum of integration and separation as situations and 2 Parts:
needs demand (1) Standards of Practice
(2) Standards of Professional Performances
Nursing Informatics
● is the use of information technologies in relation to any The Standards of Practice:
nursing functions and actions of nurses (Hannah, 1985). Standard 1: Assessment
● is a combination of computer science, information Standard 2. Diagnosis, Problems, and Issues Identification
science, and nursing science designed to assist in the Standard 3. Outcomes Identification
management and processing of nursing data, information, Standard 4. Planning
and knowledge to support the practice of nursing and the Standard 5. Implementation
delivery of nursing care (Graves & Corcoran, 1989). Standard 5a. Coordination of Activities
Standard 5b. Health Teaching and Health Promotion
Nursing Informatics (NI) Standard 5c. Consultation
Goal: provide nurses with the data, information, and support for information
processing to make effective nursing practice decisions in clinical care, research,
education, administration, and policy development. Generation of knowledge and Theories and Other Models Supporting Nursing Informatics
the application of wisdom should also occur.
Many organizations have emerged to provide information resources
Nursing informatics practice and the development of this specialty and value-added membership benefits that sup_x0002_port those individuals
have been guided by several foundational documents. These interested in healthcare and nursing informatics.
documents are:
 improving care quality, meeting clinical and business
needs, and providing capabilities for aggregated,
cross-patient data analyses and advanced decision
support and discovery.

Medicare Access and CHIP Reauthorization Act of 2015

(MACRA)
● - establishes new value-based payment models for
Medicare beneficiaries, which may improve administrative
EHR burdens and applies to physicians and nonphysician
providers, including nurse practitioners, physician
assistants, clinical nurse specialists, and Certified
Registered Nurse Anesthetists.

● - served to transition the Medicare EHR Incentive

Program (Meaningful Use) to the four components
namely, Merit-Based Incentive Payments System (MIPS),
Alternative Payment Models (APMs), and Advanced
Alternative Payment Models which require use of a
certified EHR.

Nursing Informatics Competencies

● - must be able to combine clinical knowledge with IT to
● Code of Ethics for Nurses with Interpretive Statements (2015a)
improve the ways nurses diagnose, treat, care for, and
● Nursing: Scope and Standards of Practice, Third Edition (2015b). manage patients.
● Scope and Standards of Practice, Second Edition (2015) ● - support, change, expand, and transform nursing practice
● ANA’s 2001 Code of Ethics for Nurses with Interpretive Statements through the design and implementation of IT. The ANA
● Nursing: Scope and Standards of Practice, Second Edition. (2010) ● - a specialty that integrates nursing science, computer
science, and information science to manage and
ROLE OF NURSING INFORMATICS FOR SUCCESSFUL communicate data, information, knowledge, and wisdom
OUTCOMES in nursing practice (ANA)

Informatics nurses are key contributors to a working knowledge about how

Nursing Informatics Competencies
evidence-based practices designed in information systems can support and
enhance clinical processes and decisionmaking to improve patient safety and
- Nursing Informatics Degree Programs: transform healthcare
outcomes. industry environment by helping to design the automated tools that
help clinicians, nurse educators, nursing students, nurse researches,
Nurses are the “glue” across diverse care delivery settings who are policy-makers, and consumers as they increasingly seek to manage
responsible for care coordination and promotion of wellness, and as such are their own health.
often the patient’s primary contact—and the last defensive line in care delivery
where medical errors or other unintended actions can be caught and corrected.
First Level of Competency:
- a minimum or “user” level of computer literacy and informatics
In addition, as drivers in organizational planning and process reengineering
theory
to improve the healthcare delivery system, informatics nurses are increasingly Second Level of Competency:
sought out by nurses and nurse managers and executives for leadership as their - includes the intermediate level of literacy, which includes nurses
profession works to bring IT applications into the mainstream healthcare who may work part-time on teams to design, modify, or evaluate HIT
environment (ANI, 2009). systems
Third level of competency:
- is the advanced or innovator level where a nurse has begun to
FOUNDATIONS OF NURSING INFORMATICS specialize

21st Century Cures Act HEALTH CARE DATA STANDARDS

- December 2016: authorized $6.3 billion in funding for research and
drug development; prevention and treatment of mental illnesses and - generally used to describe those standards having to do with the
substance abuse; healthcare access and quality improvement; and structure and content of health information
advancing electronic health record (EHR) interoperability, patient
access to health information, and measures to prevent information - useful to differentiate data from information and knowledge
blocking
- provides for
(1) the development and use of upgraded health IT capabilities; TERMINOLOGIES:
(2) transparent expectations for data sharing, including through open Data - collections of unstructured, discrete entities (facts) that exist
application programming interfaces (APIs); outside of any particular context
(3) improvement of the health IT end-user experience, including
reducing administrative burden Information - are data interpreted within a given context and given
meaningful structure within that context
Data standards - represent both data and their transformation into
HITECH Act information
● - provided for the incentivized adoption of EHRs by
eligible hospitals and providers across the nation, Data analysis - the process of generating knowledge; foundation of
commonly referred to as Meaningful Use, resulted in professional practice standards.
widespread adoption of EHRs, a critical foundation for
Interoperability - the ability of different information systems, devices, A embodies nursing concepts that represent the domain of nursing.
or applications to connect, in a coordinated manner, within and These essential building blocks for nursing practice can be integrated
across organizational boundaries to access, exchange, and with the data of other healthcare disciplines to provide care to
cooperatively use data among stakeholders individual patients and can be aggregated to gain insights for the care
of entire patient populations (McCormick et al., 1994).

Methods of Creating Standards: ANA-RECOGNIZED TERMINOLOGIES AND DATA SETS

(1) a group of interested parties comes together and agrees upon a
standard DATA ELEMENT DATA SET
(2) the government sanctions a process for standards to be
developed ● NMDS (NURSING MINIMUM DATA SET)
(3) marketplace competition and technology adoption introduce a de ● NMMDS ( NURSING MANAGEMENT MINIMUM DATA
facto standard SET)
(4) a formal consensus process is used by a standards development
organization (SDO) The ANA recognizes two minimum data sets, the Nursing Minimum Data Set
(NMDS) and the Nursing Minimum Management Data Set (NMMDS).

Minimum data sets

Categories of Health Data Standards ● define an essential set of data elements for describing nursing
practice or nursing management.
● Transport Standards ● Each data element has a standard definition and code that enables
● Vocabulary Standards it to be used in a variety of settings and systems, maintaining the
● Content Exchange Standards same meaning when moved from the originating system into a
larger pool of data.
● Security Standards

THE U.S. NURSING MINIMUM DATA SET

Transport Standards
● Accredited Standards Committee X12N/Insurance (ASC) X12N
● Institute of Electrical and Electronic Engineers (IEEE) NURSING
● National Electrical Manufacturers Association (NEMA) ● Care Elements
● The World Wide Web Consortium (W3C) ● Nursing Diagnosis
● Nursing Intervention
● Nursing Outcome
Vocabulary Standards ● Intensity of Nursing Care
● The Current Procedural Terminology (CPT)
● Nursing and Other Domain-Specific Terminologies: Patient or Client Demographic Elements
● ABC Codes, Clinical Care Classification ● Personal Identification
● International Classification of Nursing Practice, Logical ● Date of Birth
● Observation Identifiers Names and Codes (LOINC) ● Sex
● North American Nursing Diagnosis Association ● Race and ethnicity
● Nursing Interventions Classification (NIC) ● Residence
● Nursing Outcome Classification (NOC)
● Nursing Management Minimum Data Set Service Elements
● Omaha System ● Unique facility or service agency identifier
● PerioperativeNursing Data Set
● SNOMED-CT. • Unique identifier of principal registered nurse provider
● RxNorm • Episode admission or encounter date
● International Statistical Classification of Diseases and Related • Discharge or termination date
Health Problems:Tenth Revision (ICD-10) • Disposition of patient or client
Unified Medical Language System. • Expected payer for most of this bill

Content Exchange Standards NURSING MANAGEMENT MINIMUM DATA SET (NMMDS)

● The American Society for Testing and Materials (ASTM)
● Logical Observation Identifiers Names and Codes (LOINC)
defines 18 elements that are essential to support the
● The Clinical Data Interchange Standards Consortium (CDISC)
● The National Council for Prescription Drug Programs (NCPDP)
management and delivery of nursing care across all types of settings
● Health Level Seven (HL7) (Kunkle et al., 2012). The elements are organized into three
● National Uniform Claim Committee (NUCC) categories: environment, nursing care resources, and financial
● SNOMED International resources.

Security Standards The NMMDS supports numerous constructed variables as well as

HIPAA Security Standards for the Protection of Electronic Health aggregation of data, for example, unit level, instution level, and
Information at 45 CFR Part 160 and Part 164, Subparts A and C. network level.
ISO/IEC 27002:2013

STANDARDIZED NURSING TERMINOLOGIES Hierarchy of Elements within the Nursing Management Minimum
Data SeT
PURPOSE OF STANDARDIZED NURSING TERMINOLOGIES
● Provide valid clinical care data Environment
● Allow data sharing across todays Health Information ● Facility unique identifiers
Technology and Electronic Health Record ● Type of nursing delivery unit/service
● Support evidence based-based decision making ● Patient/client population
● Volume of nursing delivery unit service
● Facilitate evaluation of nursing processes and
● Care delivery structure and outcomes
● Permit the measurement of outcomes ● Patient/client accessibility
● Accreditation/Certification/
 ● Licensure
Nurse Resources LIMITATIONS OF EARLY MODELS FOR HCI IN NURSING
● Staffing ● Early frameworks in nursing informatics set the stage for
● Satisfaction
development of nursing information systems and their use
● Nurse demographics per unit or service
● Clinical mental work
in storing information, knowledge development, and
● Environmental Conditions development of technology in caregiving activities.
● Electronic Health Record (EHR) However, had several limitations :
● implementation stages ● lack of environmental and task-oriented elements
● conceptual differences across frameworks
● Lack of time dimensions,
INTERFACE TERMINOLOGIES ● Patients were not part of the model
are designed for use at the point of care. They use terms ● No define context nor does it include all elements of
and concepts that are familiar to practicing nurses. nursing’s metaparadigm

● Interface terminologies vary in scope, structure, and

content. They were developed by different organizations, FRAMEWORK FOR HCI IN NURSING
with different funding sources, for different purposes, with ● Informatics Research Organizing Model: which
different foci, and with different copyright privileges. emphasized all elements of nursing’s metaparadigm
including the system, nurse, patient, and health.
● CCC SYSTEM ( CLINICAL CARE CLASSIFICATION SYSTEM)
● ICNP (INTERNATIONAL CLASSIFICATION OF NURSING PRACTICE)
● Nurse – Patient Trajectory Framework : utilizes nursing
● NANDA (NANDA INTERNATIONAL) process theory, human factors, and nursing and patient
● NIC (NURSING INTERVENTION CLASSIFICATION) trajectories as components of a framework that can be
● NOC (NURSING OUTCOME CLASSIFICATION
● OMAHA SYSTEM used to evaluate patient care systems.
● PNDS ( PERIOPERATIVE NURSING DATA SET)

REFERENCE TERMINOLOGY SOCIAL DETERMINANTS OF HEALTH

reference terminology acts as a common reference point ● Social determinants of health (SDOH) data refers to the
that can facilitate cross-mapping between interface terminologies. conditions in which people live, learn, work, and play and
affect a wide range of health risks and outcomes.
SNOMED-CT SNOMED-CT was developed collaboratively by the ● An integral part of health care delivery involves
College of American Pathologists (CAP) and the UK National Health understanding these social and environmental factors of
Service (Wang, Sable, &Spackman, 2002). patients lives outside of the health care system.
● Addressing inequities in these conditions, supported in
It now falls under the responsibility of SNOMED International. SNOMED-CT part through the access and use of SDOH data, can help
possesses both reference properties and user interface terms. SNOMED-CT is
to eliminate health disparities and to improve individual
considered to be the most comprehensive, multilingual healthcare terminology in
the world concepts from many nursing terminologies.
and population health.

LOINC Logical Observation Identifiers Names and Codes FIVE DOMAINS:

(LOINC) is a universal standard that is comprised of more than ● economic stability,
71,000 observation terms primarily used to represent laboratory tests, ● education,
measurements, and observations. It is also a clinical terminology for ● health and health care,
laboratory test orders and results, clinical measures such as vital ● neighborhood and built environment, and
signs, and other patient observations (LOINC, 2015). ● social and community context.
●
As population health becomes an important focus of health care delivery, SDoH
are increasingly seen as critical factors for identifying potential upstream drivers
NURSING TERMINOLOGIES IN USE
of poor outcomes and higher costs.
● used in a variety of ways in the practice setting.
● They can provide conceptual guidance and a data model and can
link concepts from practice to granular data definitions provided by INFORMATION TECHNOLOGY APPLICABLE IN THE NURSING
reference terminologies. PRACTICE
● There are a lot of information technology applications applicable in
the hospital. It can be branched out based on the major functional
Standardized nursing data elements are needed to facilitate aggregation and departments in the hospital such as in the administration, clinical,
comparison for clinical, translational, and comparative effectiveness research, as and nursing.
well as for the development of practice-based nursing protocols and ● Various applications of information technology in this setting
evidence-based knowledge, including the generation of healthcare policy particularly focusing on patient care:
(Hardiker, Bakken, Casey, & Hoy, 2002). ● process store and integrate physiological and diagnostic
information from various sources
To support continuity of care and the exchange of data, for example, to ● Present deviations from pre-sets ranges by an alarm or an alert
implement in the United States the federal regulations for “meaningful use” (MU), ● Accept and store patient care documentation in a lifetime’s clinical
standardized nursing concepts must be interoperable between EHR systems, and repository
across healthcare settings and population groups. ● Trend data in graphical presentation
● Provide access to vital patient information from any location both
inside and outside of the critical care settings
Such demands require that the initial standardized nursing terminology concepts
be coded in a structure that is suitable for computer-based processing.
● Comparatively evaluate patients for outcomes analysis , present
clinical data based on concepts and oriented views.

HUMAN -COMPUTER INTERACTION

-
NURSING INFORMATICS: COMMUNITY HEALTH APPLICATION
is broadly defined as an intellectually rich and highly
● Support and improve collaboration among the doctors, community
impactful phenomenon influenced by four disciplines: health provider and patients. Informatics is very useful in monitoring
Human Factors and Ergonomics, Information Systems, Computer and tracking the health status of the community .
Science, and Library and Information Science (Grudin,2012).
 ● The goal of community health informatics is to attain an effective ● Lectures, sermons, addresses, dissertations prepared for
and timely assessment that involves monitoring and tracking the oral delivery, whether or not reduced in writing or other
health status of populations including identifying and controlling
material form;
disease outbreaks and epidemics.
● Tracking and detection of the disease in the community will be
● Letters;
easier ● Dramatic or dramatico-musical compositions;
● Philippine Integrated Disease Surveillance and Response choreographic works or entertainment in dumb shows;
● Musical compositions, with or without words;
● Works of drawing, painting, architecture, sculpture,
LAWS IN NURSING INFORMATICS engraving, lithography or other works of art; models or
Intellectual Property Law designs for works of art;
● refers to creations of the mind, such as inventions, literary
● Original ornamental designs or models for articles of manufacture, whether or not
and artistic works , designs and symbols , names, and registrable as an industrial design and other works of applied art;
images used in commerce. ● Illustrations, maps, plans, sketches, charts and three-dimensional works relative
Intellectual Property to geography, topography, architecture or science;
● Drawings or plastic works of a scientific or technical character;
● is protected in law through patents, copyright and ● Photographic works including works produced by a process analogous to
trademarks, which enable people to earn recognition and photography; lantern slides
● Audiovisual works and cinematographic works and works produced by a process
financial benefit from what they invent or create by analogous to cinematography or any process for making audio-visual recordings;
striking the right balance between the interests of ● Pictorial illustrations and advertisements;
innovator and wider public interest, ● Computer programs; and
● Other literary, scholarly, scientific and artistic work
● the Intellectual Property system aims to foster an
environment in which creativity and innovation can
DATA PRIVACY ACT
flourish.
Republic Act No. 10173, otherwise known as the Data Privacy Act is
a law that seeks to protect all forms of information, be it private,
REPUBLIC ACT 8292
personal, or sensitive. It is meant to cover both natural and juridical
● An act prescribing the Intellectual Property Code and
persons involved in the processing of personal information.
Establishing the intellectual Property Office, providing for
its powers and functions, and for other purposes.
● Intellectual property rights are the rights given to persons
THE IMPORTANCE OF PRESERVING ANONYMITY,
over the creations of their minds. They usually give the
CONFIDENTIALITY AND PRIVACY IN HEALTH CARE
creator an exclusive right over the use of his/her creation
● To ensure safe and compassionate nursing practice that
for a certain period of time
includes an understanding of the ethical-moral and legal
boundaries within which nurses must function vis-a-vis
RIGHTS UNDER THE INTELLECTUAL PROPERTY CODE:
protecting the patient’s rights to: respect of human dignity
● Copyright and related rights
● Trademarks and service marks
: anonymity, privacy , and confidentiality of health
● Geographic indications information.
● Industrial designs
● Patents Nurses must understand the ethico-moral and legal implications of nursing to be
● Layout designs (topographies) of integrated circuits able to determine what is good or valuable for all people and to judge what is
● Protection of undisclosed information right and wrong.
Nurses must protect themselves from liability and protect their clients’ rights
● One of the major advances in technology is the implementation of ● To ensure patient from identity theft , and other improper use of
electronic health records (EHR). patient information , specifically for financial gain.
● Healthcare facilities, physicians, pharmacies, payers, and patients ● To maintain patient’s trust.
are able to store and retrieved viable patient information and health
records electronically to promote public health . ● The integrity and availability of the electronic health information will
● Electronic health records are real-time, patient-centered records be essential for physicians and the entire clinical team to be able to
which allow information to be available instantly, whenever and trust the data for patient care and decision making.
wherever, by providing a central location for the patient’s health ● To prevent unintended consequences detrimental to health
records. The EHR can be created, managed, and consulted by research and public health practice.
providers and medical professionals across the nation by bringing ● To ensure availability of accurate health information when needed
together past medical providers, pharmacies, clinics, schools, by the patient.
diagnostic imaging, and medical facilities visits. ● To help maintain a professional attitude in health care settings
Health care software includes the software that runs devices like ● To prevent legal suits- thus avoid negative repercussions on the
health care institution’s reputation.
MRI machines, X-Ray Machines and other devices.
The Intellectual property rights each company has, is or can be specific to each
device that they manufacture. One example is GE making an MRI machine that
is ultra-quiet while maintaining image quality (GE Silent Scan). The idea or
copyright to this technology gives these companies rights to earn money from
their products for certain number of years before another company and use the
same ideas to improve on or change.
Intellectual property (IP­) of medical devices are made up of several different
aspects that one needs to ensure to in order to protect their ideas and
interventions, especially in the medical field. Medical devices can be any sort of
medical equipment that can be used by patients at home, the hospital, a nursing
home, and/or rescue squads, such as anything from a walker to ventilator
machine.

COPYRIGHT LAW
● Copyright is a collection of all rights enjoyed by the
owner of an artistic or literary work.
● Under Philippine laws.
● Books, pamphlets, articles and other writings;
● Periodicals and newspapers;