NURSING INFORMATICS

Information

is continually shared between units and departments within healthcare organizations and is also required or requested from other healthcare organizations, regulatory and government agencies, educational and philanthropic institutions and consumers

Fichman et al. (2011) identified six important elements of healthcare that may explain the lag in the development and implementation of IS:

- The stakes are life and death.

- Healthcare information is highly personal.

- Health care is highly influenced by regulation and competition.

- Health care is professionally driven and hierarchical

- Health care is multidisciplinary.

- Healthcare information system implementation is complex, with important implications for learning and adaptation.

Information Systems

- These systems collect, process, and distribute patient-centered data to aid in managing and providing care.

- Together, they create a comprehensive record of the patient's medical history and support organizational processes.

Legacy systems

An early or outdated information system (IS) that has been used in healthcare facilities for a long time. These systems may not be compatible with modern technology or other systems.

Data Silos

A situation where data and information remain confined within a particular system (such as a legacy system) and cannot be easily shared with other systems. This limits the ability to integrate and use data across different platforms.

Interoperability

is defined as the ability of a system or product to work with other systems or products without special effort from the user. It is achieved through the implementation of standards, allowing different healthcare information systems to exchange and use data efficiently. The goal is to create a seamless and patient-centered healthcare system by enabling real-time data access and improving communication between different systems.

4 Types of Health Information Technology

1. Foundational Interoperability

2. Structural Interoperability

3. Semantic Interoperability

4. Organizational Interoperability

Foundational Interoperability

Defines the requirements necessary between systems to communicate data.

Structural Interoperability

Defines syntax and format to facilitate data exchange.

Semantic Interoperability

Is more complex and refers to consistency of clinical terminology and shared meanings.

Organizational Interoperability

Refers to shared trust and consistency of policies and social and legal meanings to facilitate seamless workflow between organizations.

Types of Healthcare Organization Information Systems

• case management information systems

• communication systems

• core business systems

• order entry systems

• patient care support system

• aggregating patient and organizational data

• department collaboration and exchange of knowledge and information

Case Management Information Systems

identify resources, patterns, and variances in care to prevent costly complications related to chronic conditions and to enhance the overall outcomes for patients with chronic illness.

care plan

is an evidence-based set of care guidelines that outline the course of treatment and the recommended interventions that should be implemented to achieve optimal results.

Communication systems

promote interaction among healthcare providers and between providers and patients and are designed to be HIPAA compliant.

Examples of communication systems

• call light systems

• wireless telephones

• pagers

• email

• instant messaging,

Core business systems

enhance administrative tasks within healthcare organizations.

clinical information systems (CISs)

whose aim is to provide support for direct patient care, these systems support the administrative management of health care within an organization.

four common core business systems

• admission, discharge, and transfer (ADT) systems

• financial systems

• acuity systems

• scheduling systems.

Admission, discharge, and transfer (ADT) systems

provide the backbone structure for the other types of clinical and business systems and, when automated, provide op-portunities for health information exchange leading to care coordination

3 goals of the ADT alert system

• Improve communication across care providers

• Improve chronic care patient management

• Reduce unnecessary hospital utilization (ONC, 2013)

Financial systems

manage the expenses and revenue for providing health care.

Acuity systems

monitor the range of patient types within a healthcare organization using specific indicators.

Scheduling systems

coordinate staff, services, equipment, and allocation of patient beds.

Order entry systems

They automate the way that orders have traditionally been initiated for patients; that is, clinicians place orders using these systems, instead of creating traditional handwritten transcriptions onto paper.

Computerized physician (or provider) order entry systems

provide decision support and automated alert functionality that was unavailable with paper-based orders.

Patient Care Support Systems

focus on collecting data and disseminating information related to direct care.

The four systems most commonly encountered in health care are

(1) clinical documentation systems

(2) pharmacy information systems

(3) laboratory information systems

(4) radiology information systems.

Clinical documentation systems

also known as "clinical information systems," are the most commonly used type of patient care support system within healthcare organization.

They enhance care by putting data at the clinician's fingertips and enabling decision-making where it needs to occur, which is at the bedside.

Pharmacy information systems

They typically allow pharmacists to order, manage, and dispense medications for a facility.

streamline the order entry, dispensing, verification, and authorization process for medication administration.

Laboratory information systems

were perhaps some of the first CISs ever used in health care.

report on blood, body fluid, and tissue samples along with biological specimens collected at the bedside and received in a central laboratory.

Radiology Information System

These systems schedule, provide results, and store information related to diagnostic radiology procedures.

picture archiving and communication system (PACS)

stand-alone system, which is kept separate from the main radiology system, or it can be integrated with the RIS and CIS. These systems collect, store, and distribute medical images, such as computed tomography scans, magnetic resonance images, and X-rays.

2-6 hrs

How long does it take for images to be available in a film-based system?

Aggregating Patient and Organizational Data

Many healthcare organizations now aggregate data in a data warehouse for the purpose of mining the data to discover new relationships and build organizational knowledge.

data tiering

which is the creation of data storage tiers that can be accessed when necessary at the appropriate speeds.

database

is a structured or organized collection of data that is typically the main component of an IS.

primary key

contains a code, name, number, or other information that acts as a unique identifier for that record.

data file

is a collection of related records.

entity

represents a table, and each field within the table becomes an attribute of that entity.

entity relationship diagram

specifies the relationship among the entities in the database.

three relationships

(1) one to one, (2) one to many, and (3)many to many.

one-to-one relationship

exists between the entities of the table about a patient and the table about the patient's birth.

one-to-many relationship

exist when one entity is repeatedly used by another entity.

many-to-many relationship

reflects entities that are used repeatedly by other entities.

relational model

is a database model that describes data in which all data elements are placed in relation in two-dimensional tables; the relations, or tables, are analogous to files.

relational database management system (RDMS)

is a system that manages data using this kind of relational model

data dictionary

contains a listing of the tables and their details, including field names, validation settings, and data types.

data type

refers to the type of information, such as a name, a date, or a time.

database management system

is an important program because, before it was available, many health systems and businesses had dozens of database files with incompatible formats.

Data Warehouse

An extremely large database, or repository, that stores all of an organization’s or institution’s data and makes these data available for data mining.

Data Mart

A large database in which the data used by one of the units or a division of a healthcare system are stored and maintained.

Query

A tool that asks questions of the database to retrieve specific data and information (e.g., in Microsoft’s Access database).

SQL (Structured Query Language)

Originally called SEQUEL (Structured English Query Language),

is a database querying language used to access and manipulate databases.

SQL

is used with relational databases; it allows users to define the structure and organization of stored data, verify data, and maintain data integrity.

table

is a collection of related data that consists of columns, which are also referred to as fields, and rows, which are also referred to as records, or tuples (Peterson, 2023).

Drill down

is a term that means the user can view data warehouse information by drilling down to lower levels of the database to focus on information that is pertinent to their needs at the moment.

Blockchain technology

is showing great promise in solving some of the issues associated with traditional databases and cloud computing.

blockchain

in the simplest of terms, a time-stamped series of immutable record of data that is managed by a cluster of computers not owned by any single entity.

Department Collaboration and Exchange of Knowledge and Information

All systems require a partnership of collaboration and knowledge sharing to implement and maintain successful standards of care.

Collaboration

is the sharing of ideas and experiences for the purposes of mutual understanding and learning.

Knowledge exchange

is the product of collaboration when sharing an understanding of information promotes learning from past experiences to make better future decisions.

human-technology interface

It is this hardware and software that define the interface and how the user will interact with it

user interface (UI)

how the user will interact with it

user experience (UX)

is the user's experience from interacting with an object, product, or service.

usability

refers to the design of products and services with the user in mind in order to meet the user's needs.

Han et al. (2005) reported increased mortality among children admitted to Children's Hospital in Pittsburgh after CPOE implementation. Three reasons were cited for this unexpected outcome.

• CPOE changed the workflow in the emergency room.

• Second, entering an order required as many as 10 clicks and took as long as 2 minutes;

• Third, when the team changed its workflow to accommodate CPOE,

human-technology interaction issues.

the technology was not well matched to the users and the context of care.

INTERFACE APPLICATIONS

• NATURAL LANGUAGE USER INTERFACES

• THE CAPACITIVE TOUCH SCREEN, OR TOUCH DISPLAY

• GESTURE RECOGNITION

• NEAR FIELD COMMUNICATION INTERFACE AND PROTOCOL

• APPLICATION PROGRAMMING INTERFACE

Natural language processing (NLP)

is a discipline of computer science concerning the relationship between computers and human language that requires machine learning skills from the disciplines of Al and computational linguistics.

THE CAPACITIVE TOUCH SCREEN, OR TOUCH DISPLAY

The use of the electrical charges held in our fingertips makes tapping; swiping; scrolling; and resizing, such as zooming, easier.

Gesture recognition

requires the interpretation of human gestures via mathematical algorithms.

Near Field Communication Interface and Protocol

which provides the communication network for these devices to be interconnected.

near field communication (NFC)

secure credentialing to network the products and consumer equipment in machine-to-machine or machine-to-object interaction.

near field communication-enabled medication administration (NFCMA)

a wireless communication protocol that allows secure exchange of small amounts of data by proximity or touch"

application programming interface (API)

is an interface or communication protocol between a server and a client. It is a computing interface to a software component or a system that defines how other components or systems can use it.

VR headset, or head-mounted display

is a wearable device that you place over your eyes like goggles and use it to fully engage in the VR environment.

ecological interface design (EID)

is an approach to interface design that was introduced explicitly for multifaceted, complex sociotechnical, real-time, and dynamic systems; it has been applied in many fields, including health care.

three axioms have evolved for developing effective human-computer interactions

(1) Users must be an early and continuous focus during interface design;

(2) the design process should be iterative, allowing for evaluation and correction of identified problems; and

(3) formal evaluation should take place using rigorous experimental or qualitative methods

Task analysis

examines how a task must be accomplished.

user-centered design

the process of designing products (e.g., human-technology interfaces) so that users can carry out the tasks needed to achieve their goals with "minimal effort and maximal efficiency"

Cognitive task analysis

usually starts by identifying, through interviews or questionnaires, the particular task and its typicality and frequency.

Task analysis methods

a think-aloud protocol and cued-recall) and subsequent expert review were employed to identify the competency components exhibited by practicing endoscopists with the aim of providing a basis for future instructional design

Cognitive work analysis (CWA)

was developed specifically for the analysis of complex, high-tech-nology work domains, such as nuclear power plants, intensive care units, and emergency depart-ments, where workers need considerable flexibility in responding to external demands

A complete CWA includes five types of analysis:

(1) work domain,

(2) control tasks,

(3) strategies,

(4) social-organizational,

(5) worker competencies.

work domain

analysis describes the functions of the system and identifies the information that users need to accomplish their task goals.

control task

investigates the control structures through which the user interacts with or controls the system. It also identifies which variables and relations among variables discovered in the work domain analysis are relevant for particular situations so that context-sensitive interfaces can present the right information (e.g., prompts or alerts) at the right time.

strategies

looks at how work is actually done by users to facilitate the design of appropriate human-com-puter dialogues.

social-organizational

identifies the responsibilities of various users (e.g., doctors, nurses, clerks, or therapists) so that the system can support collaboration, communication, and a viable organizational structure.

worker competencies

identifies design constraints related to the users themselves

gulf of execution

Users need to be able to see how to use the technology to accomplish a goal (e.g., which buttons does one press and in which order to program this

gulf of evaluation

They also need to be able to see the effects of their actions on the technology (e.g., if a nurse practitioner prescribes a drug to treat a certain condition, the actual patient response may not be perfectly clear).

mapping

is used to describe how environmental facts (e.g., the order of light switches or variables in a physiologic monitoring display) are accurately depicted by the information pre-sentation.

Usability

is a term that denotes the ease with which people can use an interface to achieve a particular goal.

Surveys of Potential or Actual Users

Participants were asked their preferences for a number of design characteristics, such as display color, menu but-tons, text, photo size, icon metaphor, and layout, by selecting on a computer screen their preferences for each item from two or three options.

Focus Groups

Typically used at the very start of the design process, focus groups can help the designer better understand users' responses to potential interface designs and to content that might be included in the interface.

Heuristic Evaluation

has become the most popular of what are called discount usability evaluation methods.

is to detect problems early in the design process, when they can be most easily and economically corrected.

Formal Usability Test

typically use either experimental or observational studies of actual users using the interface to accomplish real-world tasks.

Field Study

end users evaluate a prototype in the actual work setting just before its general release.

Wearable technology

the field of mobile smart devices that are worn on our bodies, is the current rapidly evolving human-technology interface.