Key Concepts in Clinical Informatics and Nursing Informatics

Pioneers in Nursing: Contributions to NI

  • Dr. Harriet Werley: first nurse researcher at Walter Reed Army Institute of Research; promoted reuse of clinical data; first nurse on the Health Care Technology study section; helped establish the Nursing Minimum Data Set.

  • Dr. Patricia Abbott: helped develop NI as a specialty; contributed to the ANA Scope and Standards of Practice for Nursing Informatics; collaborated with the American Nurses Credentialing Center to develop NI certification.

  • Dr. Virginia Saba: coordinated distance learning projects; active in initiating academic technology programs and national healthcare standards committees.

  • Dr. Kathleen McCormick: NI scientist at NIH Clinical Center and NIH/NIA; NAS/IOM member.

  • Dr. Marion Ball: public-sector leadership; past president of the International Medical Informatics Association; AMIA board member; international advisor to the China Hospital Information Management Association.

  • Roy L. Simpson: Cerner Corporation; contributed to Nursing Minimum Data Set and NI master’s programs.

  • Dr. Linda Thede: Kent State University; developed NI programs.

  • Dr. Susan K. Newbold: founded CARING NI group (1982); contributes to NI education.

  • Dr. Susan J. Grobe: developed the Nursing Education Module Authoring System; early AMIA fellow.

Clinical Informatics and Nursing Informatics Defined

  • Clinical informatics: broad field encompassing how information systems (e.g., EHRs, barcode medication administration, imaging systems, care devices) are used in day-to-day patient care. Domains include:
    health systems,clinical care,information and communication technologies\text{health systems},\quad \text{clinical care},\quad \text{information and communication technologies}

  • Nursing informatics (NI): ANA-defined specialty (1992):
    "transforms data into needed information and leverages technologies to improve health and health care equity, safety, quality, and outcomes".

  • NI is recognized by other professional organizations as a specialized nursing practice area.

  • Data → Information → Knowledge → Wisdom progression: Data→Information→Knowledge→Wisdom\text{Data} \rightarrow \text{Information} \rightarrow \text{Knowledge} \rightarrow \text{Wisdom}

    • Data: values or measurements

    • Information: data in context

    • Knowledge: synthesized relationships and patterns

    • Wisdom: applying knowledge to solve real-world problems and drive continuous improvement

  • Types of systems:

    • Information systems: data to information

    • Decision-support systems: information to knowledge

    • Expert systems: knowledge to wisdom

  • Goals: use informatics tools (databases, imaging software, point-of-care tech) to improve patient care, reduce errors, and increase efficiency.

History of Clinical Informatics Development

  • Word origins: from Latin com (together) and putare (to think/prune); "computer" originally meant a person who computes.

  • Key milestones:

    • 1646: origin of the term computer (occupation-focused)

    • 1821: Charles Babbage builds the Analytical Engine; often credited as foundational to computing; Ada Lovelace writes early algorithm (first programmer) for Bernoulli numbers.

    • Features of the Analytical Engine foreshadow modern computers (punch cards, data storage, arithmetic).

    • UNIVAC I: designed by Eckert & Mauchly for the U.S. Census Bureau; used for census tabulation in 1950 and the economic census in 1954; widely regarded as the first successful civilian computer, signaling the computer age.

Clinical Informatics: Concepts

  • Informatics is a multidisciplinary science about data processing and communication across systems.

  • Data are values or measurements; information is data in context; knowledge is synthesized information; wisdom is applying knowledge to real-world problems for improvement.

  • Information systems, decision-support systems, and expert systems form a progression: data -> information -> knowledge -> wisdom, each with computer, communications, and human elements.

  • In clinical informatics, health care professionals use tools (databases, imaging, point-of-care tech) to capture information and support care teams; aim to reduce errors and improve efficiency and care quality.

The Culture of Health Care in the United States

  • Health care spending and size:
    $3.2×1012\$3.2\times 10^{12} USD in 2015; about 17.8%17.8\% of GDP.

  • ACA (2010): aimed to expand access and control costs; costs have continued to rise at about 5.4%5.4\% annually through 2024.

  • Health status and comparisons:

    • IOM (2011) highlighted suboptimal health in the U.S.

    • Commonwealth Fund (2014): US often ranks last among 12 industrialized nations on healthy lives, access, quality, efficiency, and equity; but ranks high in effective care and patient-centered care; lower in safety and coordinated care.

  • Fragmentation of care: overemphasis on components can miss interrelationships, delaying care and duplicating services; a barrier to improvement.

Fragmentation and Coordination of Care

  • Fragmentation example: missing patient records can harm care, especially in high-acuity settings.

    • Massachusetts data (2002–2007): 3.6×1063.6\times 10^{6} patient visits; 56.5%56.5\% multisite users.

  • Impact on chronic disease: patients with T2DM may require multiple subspecialists; poor coordination can increase ED visits.

    • Study findings: fewer primary care visits associated with more ED visits for patients with diabetes and CKD.

  • Role of clinical informatics: interoperable EHRs and data sharing help reduce fragmentation and coordinate care for better outcomes.