Nursing Informatics in Asia

Introduction

  • Asia: Largest, most populous continent.
    • 30% of Earth’s land.
    • 60% of world population.
  • Vibrant, diverse region:
    • Geography, socio-economy, culture, politics.
    • 49 sovereign countries, 48 official languages.
  • Language issues challenge health informatics programs.
    • China, Japan, Korea: Double-byte languages complicate digital record migration.
  • Asia’s diversity poses challenges:
    • Communication, information sharing, standards implementation, manpower training.
  • Health informatics development correlates with socio-economic progress.
    • Depends on government, industry commitment to infrastructure.
  • Chapter overview:
    • eHealth initiatives in Asia.
    • APAMI academic activities.
    • Nursing Informatics in South Korea, Japan, Taiwan.

eHealth Initiatives in Asia

  • APEC region eHealth collaboration:
    • Started in 2000, APEC leaders recognized the digital divide.
    • Supported underprivileged populations.
  • 2001: Addressed basic health issues using ICT to broaden healthcare services.
  • 2003: Health security focus, surveillance network for disease outbreaks, bio-terrorism.
  • 2005: Ministerial meeting emphasized ICT for health threats, welcomed eHealth Initiatives.
  • 2006: APEC eHealth Seminar, Action Project launched.
  • 2009: APEC eHealth Community introduced.
    • Shared information, exchanged resources between developed and underdeveloped economies.
    • Promoted government participation in policy, legislation, standards.
    • Encouraged APEC member participation via seminar hosting.
  • APEC eHealth Community Forum:
    • Annual meeting.
    • Objectives: Bridging gaps, capacity building, acknowledging eHealth successes, vitalizing eHealth industries.
    • Activities: Technical presentations, exhibitions, poster presentations with experts from industry, academia, and research institutes.
    • Support scheme based on eHealth status:
      • Initiative-level: Information sharing, awareness promotion.
      • Mid-level: Technology development via health IT information.
      • Advanced-level: Introducing new eHealth technology.

Asia-Pacific Association for Medical Informatics (APAMI)

  • Established 1993 as IMIA regional member.
    • Promotes regional cooperation, health informatics development.
    • 15 society members: Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, Philippines, Singapore, Sri Lanka, Taiwan, Thailand, Vietnam.
  • Activities: Triennial conferences, working groups.
    • Inaugural conference: Singapore, 1994.
    • Subsequent conferences: Sydney (1997), Hong Kong (2000), Daegu (2003), Taipei (2006), Hiroshima (2009), Beijing (2012).
  • Working groups: Standardization, Health Informatics for Developing Countries, Decision Support, Nursing Informatics.
    • Workshops during APAMI conferences.
  • Promotes: Telemedicine, bioinformatics, public health informatics.
  • Telemedicine:
    • Major player due to large countries, low specialist-to-population ratio, affordable technology, high ICT penetration.
    • Example: Oncology center network in Japan (14 centers, 130+ teleconferences/year, 16,000 participants).
    • Active projects: China, Korea, Australia, India, Bhutan, Singapore, Indonesia, Hong Kong, New Zealand.
  • Bioinformatics:
    • Actively promoted in China, Hong Kong, Japan, Korea, Singapore, India, Malaysia, Thailand, Philippines.
  • Public health informatics:
    • China, Hong Kong SAR, Singapore, Taiwan active post-SARS (2003).
    • APAMI addresses research & development in contact tracing, epidemiological reporting, monitoring for acute disease outbreaks.

Overview of Nursing Informatics in Asia

  • Computers introduced in Asian healthcare in the 1970s.
  • Rapid growth in healthcare informatics with ICT advancements.
  • Initial applications: Administration, billing, insurance.
  • Shift towards paperless electronic health records.
  • Governments crucial in introducing IT:
    • Funding, infrastructure, policies.
  • Professional organizations also played an important role
  • Computers used in nursing in the early 1970s, but health informatics/NI introduced later (1980s/90s).
  • Adoption of informatics:
    • Vision of individuals in government/professional organizations.
    • Supported nurses in nursing care practice, education, research, IT industry, government departments, existing professional organizations.
  • Nursing schools recognizing the importance of informatics courses.
    • Basic computer literacy is now part of nursing education.
    • Graduate programs in NI available in South Korea and Taiwan.
  • NI research reports began in the 1990s.
  • Information technology: initially appeared as an educational tool, before being used in clinical practice, such as expert systems and electronic nursing records.
  • Clinical practice: led to the development of standards and research topics: terminology and classification, decision support systems, mobile computing, and telemedicine.
  • External events catalyzed adoption.
  • International links assisted beginnings and progression.
  • IMIA triannual conferences expedited progress in South Korea and Japan (1980, 1997).
  • APAMI formation in 1993 promoted national healthcare informatics associations.
  • China, Japan, and Korea Medical Informatics Associations (formed in 1999) fostered knowledge exchange.
  • Chapter provides overview of historical events in South Korea, Japan, and Taiwan.
    • Highlights crucial factors for success in healthcare informatics.
  • Summarizes significant events and their impact on NI evolution.

South Korea

  • Located in the Far East, Korean Peninsula.
  • Area: 99,392 km299,392 \, \text{km}^2 (70% mountainous, 21% cultivated).
  • Fourth largest economy in Asia-Pacific, 13th largest globally.
  • 2009 Population: ~50 million (mostly urban).
  • Life expectancy (2011): 81.3 years (exceeds OECD average of 81.1).
  • Hospital beds (2011): >9 per 1000 individuals (2nd highest in OECD).
  • Physicians (2011): 2.0 per 1000 individuals (8th lowest in OECD).
  • Nurses (2011): 4.7 per 1000 individuals (lower than OECD average of 8.8).
  • Universal health insurance introduced in 1989.
    • Covers hospital stays, physician visits, prescription drugs.
  • Healthcare industry is growing, with biotechnology and health informatics as growing segments.
  • Health informatics growth attributed to IT sector and KOSMI outreach.

History of Nursing Informatics in Korea

  • Computers in healthcare (late 1970s): Hospital finance and administration for insurance reimbursements.
  • National health insurance expansion led to necessity of computers for reimbursement.
  • Health informatics/Nursing informatics terms introduced with KOSMI foundation in 1987.
  • Nursing Informatics Special Interest Group (1993) within KOSMI.
  • Nursing highly visible in KOSMI.
    • Presenting and publishing papers on computer use in nursing.
    • >200 active KOSMI members are nurses.
  • Korean nurses participate in international conferences by IMIA and IMIA-NI.
  • IMIA conference MEDINFO98 and IMIA-NI conference NI2006 held in Seoul provided opportunities for Korean nurses to become acquainted with nursing informatics at the global level.
  • Funding for NI study group by Korean Science and Engineering Foundations since 1998.
    • Activities: Journal reviews, research (e.g., surveys on NI education, computer applications in nursing practice).

Use of Information Technology in Clinical Practice

  • 2005 Report (Korean Hospital Association):
    • 100% tertiary hospitals, 98.7% community hospitals, 95.4% physician offices have admission/discharge/transfer systems.
    • Driven by financial factors (medical insurance claims).
    • Shifted focus to patient care as clinicians used computers.
    • ~100% tertiary hospitals, 84.2% community hospitals, 66.9% physician offices use computerized provider order-entry systems.
    • 90.5% tertiary hospitals, 78.6% community hospitals, 22.6% physician offices have PACS.
      • Driven by government reimbursement rates for diagnostic radiology using PACS in early 2000s.
    • Hospitals implementing paperless EMR systems.
      • 2010: 50.2% tertiary, 35.0% general hospitals have basic or comprehensive EHR systems (Yoon, Chang, Kang, & Park 2012).
  • Computer use in clinical nursing began in medium-sized hospitals.
    • Initially for administration and billing.
    • Nurses view work lists on screens/printouts instead of manual methods.
  • Nursing information systems proliferated with large hospitals (1000+ beds) in mid-1990s.
    • Included nursing assessment, care plans, patient classifications.
    • Activities related to billing, managerial/coordinating tasks, physician-delegated tasks.
  • Hospitals implementing paperless electronic nursing record (ENR) systems.
    • Standardized nursing terminology (based on ICNP) integrated into ENR system at Seoul National University Hospital (2003).
    • Data stored in clinical data repository, used for research and clinical practice (Ahn & Park, 2013; Park, Cho, & Ahn, 2012).
    • Detailed clinical model-based electronic nursing records system under development (Park, Min, Jeon, & Chung, 2012).

Nursing Informatics Education

  • IT is indispensable in healthcare, impacting healthcare professionals.
  • Nursing schools realizing the importance of health informatics education.
  • 2010 survey:
    • 69% (78/135) of nursing schools with baccalaureate programs offer nursing informatics courses.
    • 40.8% (29/71) of nursing schools with three-year diploma programs offer nursing informatics courses.
  • Courses taught under different titles.
  • Course contents vary greatly, instructors are often self-taught.
  • Need to identify content to cover and standardize programs.
  • Informatics being added to graduate-level curriculum.
  • Only one graduate program specializing in nursing informatics in Korea.
    • Seoul National University College of Nursing (since 2003).
    • Awards master’s and doctoral degrees.
    • Plays a role in producing nursing informatics practitioners and educators.

Nursing Informatics Research

  • Since introduction of medical informatics and nursing informatics in 1987 in Korea, there have been many research studies on the use of information and technology in the healthcare field.
  • Identified trends of nursing informatics research since in 1989 in Korea by reviewing nursing informatics–related literatures published in Korea (Lee & Park, 2009).
  • Reviewed abstracts of oral and poster presentations at KOSMI bi-annual conferences and papers published in the Journal of Korean Academy of Nursing, Korean Journal of Nursing Query, and Journal of Korean Academy of Adult Nursing.
  • Included all of the abstracts and articles that were either authored by a nurse researcher or had relevance or application to nursing.
  • A total of 192 papers were reviewed to examine the research trend of NI in Korea.
  • Grouped the NI research into the following seven areas: clinical practice; teaching and learning; decision support; public and consumer health informatics; patient-centered healthcare such as telemedicine and ubiquitous healthcare; standardization activities; and use of IT for nursing research.
  • The number of NI-related papers published in Korea has increased dramatically over the past 20 years.
  • Early studies on the use of computers for clinical nursing practice in the late 1980s and 1990s focused on attitudes toward or changes in workflow after computerized patient order entry (CPOE) implementation.
  • In the mid-2000s, as terminology-based ENR systems were introduced, the outcomes of ENRs were studied in terms of direct and indirect care time and user satisfaction.
  • Patient safety programs became part of the ENR.
  • Quite a few papers have been published on the use of IT as a tool (e.g., CD-ROM, computer-assisted instruction, and Web-based learning) for learning and education in Korea.
  • In the late 1990s and late 2000s, the popular research was in the area of decision support.
  • With an aging population and increasing numbers of patients with aging-related diseases, there is a need for patient-centered healthcare such as telemedicine.
  • Standardization activities in Korea are widely published and include work such as care plans, nursing practice guidelines and critical pathways, nursing document forms, and the use of nursing terminology for ENR systems.
  • Information technology has been used for research into nursing and for data analysis, including both qualitative and quantitative research.
  • The growing interest in IT has been reflected in nursing research in Korea.
  • Over last two decades, the introduction of EMR and ENR systems, health informatics education, and health informatics research have either directly or indirectly influenced the development and expansion of NI research in Korea.

Standardization Activities

  • Efforts to introduce health informatics standards in South Korea.
    • Primary motivation: Compatibility of data, clinical documentation, and research outcomes.
  • Korean experts actively involved in international standards development organizations (ISO, HL7).
  • Korean Ministry of Health introduced a Health Informatics Standards Committee (2004).
    • Develop a single, integrated healthcare terminology
    • Committee in charge of developing, disseminating, and maintaining healthcare terminologies.
    • 14 sub-committees working on terminologies in different areas.
      • Nursing Sub-committee translated existing nursing terminologies (NANDA, NIC, CCC, Omaha System, ICNP) into Korean.
      • Collected and standardized nursing statements documented in nursing records and mapped them to the ICNP.
      • Outputs available for Korean hospitals to use in their electronic patient record systems.

Government Initiatives

  • Korean government initiated information systems planning for the public health sector and the National Health Information Infrastructure in 2005.
  • Established the Center for Interoperable EHR (CiEHR) in 2005.
    • Role: Develop core technologies to implement a lifetime EHR.
    • Enables public to access and use their own medical record anytime and anywhere.
  • Lifetime EHR:
    • Medical practitioners can provide diagnoses and treatments with enhanced accuracy based upon sufficient patient data.
    • Public benefits by receiving higher-quality medical care.
    • Reduces costs and risks of medical care, eliminates redundancy in laboratory tests and prescriptions.
    • Promotes public health and chronic disease management, as it establishes the foundation for receiving systematic lifetime healthcare services.
  • First two years, CiEHR established plans for a national healthcare information system.
  • Center engaged in ongoing development of infrastructure for the next-generation EHR system:
    • Integrated medical terminology and data model
    • Administered service management system
    • Clinical decision support system.
  • Research and development by CiEHR is the outcome of collaboration with the 30 EHR- associated hospitals and 21 participating companies.
    • Effort will be the cornerstone for utilizing health IT in the public healthcare sector and disseminating health IT to the private healthcare sector
  • The research outcome of CiEHR creates a synergy effect through collaboration with national health IT projects, and public and private healthcare organizations.
  • The ultimate goal of CiEHR is to enable the nation to conveniently receive healthcare at anytime and anywhere by practicing safe exchange of medical information between healthcare organizations.
    • Aims to produce practical outcomes that can be applied by real users in real situations.

Professional Outreach

  • Since its inception in 1987, the KOSMI has played a key role in promoting and developing health informatics in Korea by holding bi-annual academic conferences, various seminars, workshops, and open forums, and by publishing journals.
  • KOSMI has also offered educational programs for beginners in health informatics.
  • Professional organizations such as the Korean Medical Association and the Korean Nurses Association have also played significant roles by including health informatics in their continuing education programs.
  • Another healthcare informatics expert group, the Health Informatics Standardization Committee, serving as the South Korean technical advisory group of the ISO Technical Committee 215, has held open forums and published health information standards.
  • The IMIA has contributed significantly to furthering the knowledge of South Korean healthcare professionals about worldwide trends in health informatics.
  • South Korean experts in health informatics have attended and participated in many international conferences and meetings promoted or sponsored by the IMIA since 1989.

Technology Trends

  • Mobile computing in healthcare:
    • Popular due to rapid growth in mobile telephone users (92% of the total population) and advances in wireless LAN.
    • Main users: Nurses attending patients at bedsides.
    • Favored platforms: Notebook computers with wireless LAN connections because of their large screen size and easier-to-use interface.
  • Telemedicine:
    • Growing need due to increasing numbers of elderly, patients with chronic diseases, and patients discharged early.
    • Teleconsultation system initiated by the Korean government.
      • Primary care physician in a remote area to have a telepathology or a teleradiology consultation with the specialists of a tertiary hospital.
    • Telecare at home:
      • Telecare Center of Seoul National University Hospital and the Telemedicine Center of Gil Hospital being among the most active telecare-at-home clinics.
      • Telepractioners at these centers maintain special schedules for their remote clients. They set aside one to two days per week to take care of their clients using virtual reality technology via the Internet.
    • Teleconsultation fee is reimbursed by health insurance, but the use of telecare- at-home clinics is not covered.
    • In July 2009, the Korean government began permitting telemedicine between healthcare professionals and clients.
  • Ubiquitous computing in healthcare:
    • Healthcare is available to everyone, everywhere without any dependence on time and location and where the technologies enabling ubiquitous healthcare will be assimilated flawlessly in our daily lives such that the technologies become invisible (Sneha & Varshney, 2006).
    • Alternative to traditional face-to-face healthcare services in Korea.
    • Since revision of medical laws to include e-prescriptions and telehealth was passed in 2002, several attempts were made to utilize ubiquitous computing in healthcare in both public and private sectors in Korea.
    • The Korean government initiated various pilot projects to promote ubiquitous computing in healthcare such as the Smart Digital Home, Health Management, and Health Promotion projects that use ubiquitous IT for underprivileged populations; the Ubiquitous Home Healthcare project for the elderly; and the u-City project.
    • The local governments have also initiated various ubiquitous healthcare trials such as health center–based home healthcare, telemedicine in rural underserved regions, telemedicine for the elderly in nursing homes, and tele-emergency services.
    • Private sector:
      • B2C ubiquitous healthcare model, which was developed to help manage chronic diseases (e.g., diabetes and hypertension), promote health in the general population (e.g., exercise, diet, and life style management), and support disease prevention in the private sector.
      • B2B model, where medical information solutions companies collaborate with healthcare organizations and insurance companies to provide ubiquitous healthcare services.
    • Consortium collaborating in ubiquitous healthcare in Korea: major healthcare organizations, leading telecommunication companies, universities and government research institutes, medical device and sensor companies, medical information solutions companies, and the safety and security industries.
    • Pilot project, developing ubiquitous healthcare models for private clinics and major healthcare organizations, involving about 8000 patients with diseases such as diabetes, hypertension, cancer, chronic respiratory disease, and metabolic syndrome.
    • Ubiquitous computing use cases in nursing:
      • Home care nurses send data measurements of their clients to doctors at health centers. Doctors monitor data measurements sent by the home care nurses and send recommendations to the nurses’ PDAs. Nurses, in return, deliver nursing care to home care clients using short message service (SMS) systems or phones.
      • Community health practitioners share bioinformation collected from clients with hypertensive and diabetic medications with doctors. Nurses prescribe and dispense medications for the patients based on doctors’ orders delivered to them via wireless networks.
      • Nurses working in nursing homes can consult with doctors at a hospital located remotely via teleconferencing technology.
      • Nurses working in community settings and for vendors are actively involved in different types of ubiquitous healthcare activities as healthcare providers, business model planners, and developers.

Japan

  • Population: ~127 million.
  • ~10,000 hospitals, ~430 with >400 beds.
  • ~852,000 nurses, ~220,000 nurse aides.
  • ~278,000 medical doctors, 97,000 dentists, 253,000 pharmacists (JNAP, 2013; Health and Welfare Statistics Association, 2009).
  • Healthcare delivery system:
    • Easy access, free choice of institutions/doctors.
    • Financial contribution proportional to income. (Insurance fee deducted from the monthly salary and pooled by each insurance union)
    • Insured individuals and families pay 20% and 30%, respectively, of all health expenditure.
    • Government contributes a maximum of 70,000 yen to treatment during a one-month hospital stay.
    • Low out-of-pocket cost ensures security.
  • Total health expenditure is lower than in other advanced nations.
    • Attributed to dietary habits, small number of healthcare professionals.
    • Shortened hospital stays.
    • Need for health informatics to improve medical safety.

Health Informatics in Japan

  • Attention to computers in healthcare: late 1970s, following other industries.
  • Japan hosted MEDINFO80 (International Medical Informatics Association conference) in 1980.
  • Japanese Association of Medical Informatics (JAMI) founded to support health informatics.
  • JAMI held 24 annual and bi-annual academic conferences, contributing to progress of health informatics in Japan.
  • Initial research: Computerized billing systems for medical fees, use of personal computers at an individual level.
  • Shifted to organizational level: Hospital and regional information systems, basic information technology for healthcare.
  • Current focuses: Ethical issues, medical finances, and quality assurance.
  • Scope of health informatics has expanded.
  • Medical information departments in about 50 national university hospitals have made the largest contribution to the development of health informatics in Japan.
  • Each organization has been developing its own hospital information systems for its own applications to clinical practice, education, and research.
  • Work helped Japan to determine the information, information technology, and mechanisms that were needed for healthcare applications, but the independence of these applications has hindered standardization in many healthcare fields.
  • Standardization is one of the many problems in the use of healthcare information technology that needs to be resolved.

History of Nursing Informatics in Japan

  • The ird International Congress on Medical Informatics, MEDINFO80, organized by the International Medical Informatics Association, was held in Tokyo in 1980.
  • This congress included a special interest group on nursing informatics, which represented the beginning of nursing informatics in Japan.
  • This did not result in immediate progress in Japanese nursing informatics education, due to schools being vocationally oriented.
  • However, in the late 1990s nursing education in Japan rapidly shifted to a more academic orientation, and there are now more than 100 universities offering baccalaureate programs and 40 universities offering graduate programs.
  • Some baccalaureate programs and graduate schools include nursing informatics courses in their curricula.
  • Nursing informatics was applied more in clinical practice than in academic fields during the 1990s, with more nurses learning about utilizing computers in nursing practice through the activities of medical information departments in national university hospitals.
  • It was also evident that clinical nurses presented more papers than academic researchers at the annual meetings of the JAMI.
  • The Annual Meeting for Nursing Information Systems that was established as a task force of the JAMI also supports clinical practice, and most of its members are clinical nurses.
  • The Nursing Division of the JAMI was established in 2000 and is managed by a team of clinical nurses and academic researchers.
  • Several textbooks on nursing informatics have been published, but systematized nursing informatics education has not yet been implemented.
  • The Japanese Nurses Association prepared a course on nursing information management as the first step toward a continuing education curriculum for ward managers.
  • The standard textbook was published in March 2004.
  • The lecturers are researchers of health informatics and nursing informatics, and clinical nurses working at the hospitals where hospital information systems were introduced.

Nursing Informatics Practice

  • Becoming a specialist in nursing informatics is useful when hospital information systems and electronic health records are introduced.
  • However, the accreditation program of the Japan Nursing Association does not recognize the training for such specialists.
  • Instead, the training of informatics nurses mainly occurs in hospital settings.
  • In each hospital, nurses working on medical information are active in committees and working groups.
  • Most of them are involved with not only nursing-related work but also medical- information-related work.
  • Their lack of formal technical education often causes difficulties, and hence it is predicted that the importance of nurses with nursing informatics education will increase.
  • The JAMI began an accreditation program for healthcare information technologists in 2003.
  • Hospitals are looking for new healthcare staff with knowledge of both healthcare and information technology who can control information flow.
  • Although a healthcare information technologist is a healthcare professional with such training, it is necessary to distinguish between the roles of the nursing informatics clinical nursing specialist and a healthcare information technologist.
  • Informatics nurses will be expected to expand their activities in healthcare when both professions are introduced to hospitals.

Nursing Informatics Education

  • As of April 2013, there were 522 professional schools, 27 junior colleges, 218 universities, and 121 graduate schools in Japan, compared with 461 professional schools, 74 junior colleges, and 30 universities in 1994.
  • This comparison illustrates that nursing education in Japan has shifted from professional schools to universities and postgraduate education in the past six years.
  • However, there are still very few universities with separate nursing informatics programs.
  • The increasing development of hospital information systems in Japan has led to discussions on the utilization of information technology in clinical nursing practice.
  • Continuous education of nursing informatics is being emphasized, along with the promotion of electronic health records.
  • However, it is difficult to conclude that the curricula of nursing schools have reflected the changes in society and clinical fields.
  • Rather, it appears that clinical practice is now more advanced than nursing education.
  • Universities provided elementary computer literacy education during the first half of the 1990s, but this became unnecessary thereafter due to the introduction of computer education into elementary and junior high schools.
  • Overall, the teaching of computer literacy on document retrieval, utilization of statistical processing, and Web utilization has increased, but barriers to the development of nursing informatics remain in Japan: (1) there are few researchers and educators in nursing informatics, (2) there is little development of educational tools, and (3) the cost of improving the network and computer environments is high.
  • However, the importance of universities providing a satisfactory curriculum is being recognized due to the increasing importance of nursing informatics, with this being more so in graduate schools than in baccalaureate education.

Nursing Informatics Research

  • The amount of nursing informatics research is increasing in Japan; the two main purposes of which are improving the quality and standardization of nursing practice.
  • Nursing informatics was one of the main subject areas of paper presentations at a recent annual meeting of the Japanese Academy of Nursing (Japan Academy for Nursing Science, 2003), indicating that it is becoming one of the major areas in nursing.
  • There were many reports on research into the use of information technology as an educational tool during the 1990s, and on the use of information technology in clinical practice, especially on decision support systems for nursing in hospital information systems and electronic health records
  • There has also been research into the use of information to prevent nursing-related accidents and into telenursing
  • Research into nursing-practice algorithms using thinking-aloud methods have begun in Japan.

Japanese Government Initiatives and Standards Development in Japan

  • An “e-Japan” strategy encompassing all Japanese ministries and related agencies is progressing now in Japan.
  • The adoption of EHR is one of the main themes in the healthcare sector.
  • The Ministry of Health, Labor, and Welfare announced a grand design for healthcare, and set the following achievement goals for 2006: (1) electronic health records will be introduced into 60% of hospitals with more than 400 beds, and into 60% of clinics, and (2) the electronic health expenditure payment system will be introduced into 70% of all hospitals.
  • Standardization of the terminology used in electronic health records is a requirement for achieving this goal, and the Ministry of Health, Labor, and Welfare has begun a project for developing a national standard, which is publicly available on the Internet.
  • This is especially useful for hospitals introducing hospital information systems for the first time.
  • The following five standards have already been completed:
    • (1) 581 facilities now perform medical diagnoses using the ICD-10;
    • (2) 330 facilities have surgical and medical treatment standards;
    • (3) 5700 clinical tests have been registered in the clinical laboratory test standard;
    • (4) about 38,000 drug names have been registered by 203 enterprises; and
    • (5) about 210,000 medical supplies have been registered by 336 enterprises.
  • Standardized symptoms, physiologic function examinations, imaging tests, dental terminology, and nursing terminology are currently under development, and nursing actions and observation items in nursing terminology will be available to the public by the middle of 2004.
  • The terminology used in nursing practice have been collected, analyzed, and re-designed.
  • About 260 fundamental nursing practices have been identified and named in Japan.
  • They have been categorized into daily-life care, family support, guidance and education, inter-organizational coordination, care in the usage of equipment, and care for the terminally ill and the bereaved family, and others.
  • There are two hospitals utilizing the terminology describing nursing care plan and nursing order and implementation of care.
  • Difference in the nursing care offered to patients became clear.
  • Continuous 24-hour observation of nursing care can be shared, indicating that the use of such a system is very useful for the medical profession.

Nursing Informatics in Taiwan, Hong Kong, and China

Nursing Informatics History

  • The Taiwan Nursing Informatics Association (TNIA) was established in 2006. Since then NI has become an important nursing professional specialty in Taiwan.
  • TNIA has taken many strategic steps to get supports; its members have learned from international organizations, such as IMIA NI SIG, AMIA NIWG, ANI, TIGER.
  • It has held many international and local conference workshops to inspire many nurses to gain an interest in NI every year.TNIA’s progress resulted in being granted to host the office of National EHR Projects by the Ministry of Health in the early 2010s.
  • Currently, all medical centers and many hospitals in Taiwan have set up NI specialist positions and formed a NIS multi-professional development task force.
  • Nursing information systems have become widely implemented applications within clinical settings.
  • Many creative and award-winning NIS projects such as smart handheld medication administration with strong double-checking safety design were initiated.
  • With TNIA’s responsibility of holding the 12th international congress on nursing informatics (NI2014), the support and blessings received from global NI communities have helped mobilize nursing leaders and various professionals to work together in demonstrating the achievements and visions of NI in clinical nursing, nursing education, research, as well as administration.
  • The local NI2014 committee organization has become the best platform for NI leaders in Taiwan to work together.
  • In terms of results, this active mobilization made Taiwan achieve the first breaking record of submissions. Its submitted papers and posters, covering various topics, outnumbered those from other countries, including the United States.
  • Out of 258 total conference papers and posters, 84 were from Taiwan, compared with 66 from the United States and only 1 from Taiwan for the NI2003 conference.
  • This achievement in Taiwan, within its first 10 years of TNIA’s existence, could not be made without the high-quality nurses, hardworking hospital IT personnel, and committed nurse leaders.
  • Taiwan is making its strategic plan to join the global NI community to work with other countries to develop their NI professionals.
  • The Republic of China inaugurated its Nursing Informatics group at the Asia-Pacific Association for Medical Informatics (APAMI) meeting held in Beijing in 2012.
  • Dr. Ying Wu, the Dean of School of Nursing, Capital Medical University, successfully organized the first China National Nursing Informatics Conference in Beijing in October of 2013. She is also the current President of APAMI.
  • Working with Dr. Polun Chang, she began to organize the NI courses and workshops in Beijing.
  • The National Institute of Hospital Administration (NIHA) is the main governmental organization in China. NIHA has the largest mobilization and impact in the formation of national as well as local policy of developing hospital information systems, including nursing information systems.
  • It is working with the China Hospital Information Management Association (CHIMA) to hold their national conferences, called the Chinese Hospital Information Networking Conference (CHINC), which attracts more than 3000 attendants nationwide every year.
  • CHIMA organized the largest nursing team to promote nursing informatics, thanks to the long leadership of Dr. Baoluo Li and Dr. Yu-Xiu Gong, who are currently editing the first nursing informatics textbook in China.
  • The other NIHA leader, Dr. Li Yao, has taken another route to affect the development of nursing informatics by educating the national nursing leaders.
  • Outside the hospital context, the China Medical Informatics Association (CMIA), via its Chinese IMIA representative, is playing the other driving force in promoting nursing informatics.
  • As from 2012, Dr. Polun Chang and Ming-Chuan Kuo had actively participated at various national and local conferences, training workshops in China on behalf of NI2014 and TNIA, to demonstrate the meanings and values of nursing informatics, as well as the global trends such as the case of Technology Informatics Guiding Education Reform (TIGER).
  • TNIA also invited leaders from China to attend the conference in Taiwan to exchange insights and build connections.
  • Nursing informatics communities in China, Taiwan, and Hong Kong have worked well together. We believe that future cooperation will be closer and better.
  • Fully and sincerely supported by the TNIA, a special China Nursing Informatics Forum is set up for NI2014 to link the nursing informatics expertise cross China, Taiwan, Hong Kong, and global NI community.
  • In June 2014, the TNIA hosted NI2014, the successful 12th international congress on nursing informatics in Taipei.
  • Hong Kong hospitals have a well-established Clinical Management and numerous other associated systems widely used by nurses.
  • Hong Kong nurses established NURSINFO (HK) Ltd. in 1991, and this organization has enjoyed a consistent increase in membership. They have as their motto, “Nursing Informatics for Excellence in Patient Care