NURSING INFORMATICS AND TELEHEALTH NURSING I. NURSING INFORMATICS

Information Technology • Any technology which processes and communicates data, includes: • Computers, voice, data, and image sensing and communication devices, graphics devices, multimedia storage, etc. • Pen, paper, telephones and fax machines.

Nursing Informatics (NI)

 Computer science, information science, and nursing science combined to assist in the management and processing of nursing data, information and knowledge to support the practice of nursing and the delivery of nursing care (Graves and Corcoran, 1989).

 Intersection point with nursing science, computer science and information science (Turley, 1996).

 Is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. Nursing Informatics facilitates the integration of data, information and knowledge to support patients, nurses and other providers in their decision-making in all roles and setting (Nursing Informatics: Scopes and Standards, ANA 2008).

At this time, these are the computer system that nurses use:

1. Management Information System – This is a designated department that facilitates the organization and application of data used to manage an organization or department. For instance, upon entering the hospital, the admitting section will enter the personal data of the patient to their computer. This computer is actually a centralized one. It means that the information about the patient can be seen in the emergency room, laboratory as well as to the other units that has something to do with the patient. Anything that they have done such as purchases of medications and laboratory results are reflected in a record intended for the single patient. The MIS serves as a way to prevent duplication of data of patients and keeps up the flow of patients especially those old patients. 2. Hospital Information System – It is system catered to the types of data needed to manage client care activities and health care organizations. The personnel in these areas enter the data needed to allow management of billing. The Management Information System and the Hospital Information System actually works hand in hand.

Purpose of Nursing Informatics:

1. For Nursing Education – Through nursing informatics, nursing students can retrieve literature. Computers have significantly present huge amounts of data and catalogues which can search systematically. The tedious job of organizing literature was greatly reduced with computer systems. Users can access statistics from the Centre for Disease Control and Prevention, get census and even the current mortality and morbidity of a certain type of disease or group of population in just one click. 2. Computer- Assisted Learning – Nursing students can enjoy learning the basic nursing care through software programs. Programs may cover topics from drug dosage administration to ethical decision making. Programs have been intended to certify the aptitude of nursing students about electrocardiogram and other important nursing activities that is important in the real work set-up. 3. Distance Learning – Through nursing informatics, online degrees in nursing and continued professional education have been a trend. Teachers can now reach a wider group of students. Homework or assignments can be sent via the internet without even facing the educators or meeting them in personal. The physical distance between the educator and the student is now shortened. 4. Documentation of Client Status and medical records – Nursing informatics can make the impossible organization of huge records possible. Research about past medical illness and management are easier since a computer keep the records and the researcher will just get proper access to that information.

Nursing Informaticists Works with Web Support • In education, the nurse informaticist works with online, hybrid, and web supported courses. This may include putting courses up on the internet and assisting faculty with determining what should go on the web support sites. Core Competencies • The Entry Level Nurse • Knows how to use nursing specific software such as computerized documentation; use of patient care technology and information management for patient safety. • The Experienced Nurse • Skilled in information management and computer technology to sustain their specific area of practice, includes making judgments based on trends of data in addition to collaboration with the informatics nurses in the development of systems.

• The Informatics Nurse Specialist (INS) • Has advanced informatics preparation at the graduate level and assists the practicing nurse in meeting his needs for information. Has advanced informatics preparation and possesses skills for conducting informatics research along with theory development. Application of Nursing Informatics

Nursing Practice • Worklists to remind staff of planned nursing interventions • Computer generated client documentation including discharge instructions and medical information • Monitoring devices that record vital signs and other measurements directed into the client record • Automatic billing of supplies of procedures with nursing documentation • Reminders and prompts that appears during documentation to ensure comprehensive charting. • Quick access to computer-archived patient data from previous encounters • Online drug information

Nursing Administration • Automated staff scheduling • Online bidding for unfilled shifts • Electronic mail for improved communication • Cost analysis and finding trends for budget purposes • Quality assurance and outcome analysis • Patient tracking and placement for case management

Nursing Education • Online completion of mandatory requirements • Online course registration and scheduling • Computerized student tracking, testing and grade management • course delivery and support for Web-based education • Remote access to library and internet resources • Teleconferencing and webcast capability • Presentation software for preparing slides and handouts • Online test administration • Communication with students

Nursing Research • Computerized literature searching • The adoption of standardized language related to nursing terms • The ability to find trends in aggregate data, which is data derived from large population groups • Use of internet for obtaining data collection tools and conducting research • Collaboration with other nurse researchers

Advantages of Nursing Informatics

• Improved access to information • Error reduction and improved communications • Decreased redundancy of data entry • Convenience • Decreased time spent in medication administration and documentation • Increased time for client care • Facilitation of data collection and research • Improved quality of documentation • Improved compliance with regulatory requirements • Improved record security • Improved quality of care and patient satisfaction • Decreased administrative costs for location and maintenance of client record • Creation of lifetime clinical record facilitated by information systems.

Disadvantages of Nursing Informatics

• Decrease communication and socialization between nurse and patient • Increased costs to startup, maintain, train, and upgrade • Computer literacy required • Confidentiality, privacy and security difficult to guarantee • A complex conceptual design process • The need for multiple external databases • The need to hire database-related employees • A more complex programmer environment • Potentially catastrophic program failures • A longer running time for individual applications

The Future Now

 Include nursing workflow as a focus of healthcare IT funding to ensure that systems and devices will enable nurses to be more efficient and produce safer care.  Advocate for nurses to be included in technology design and evaluation to enhance rapid adoption.  Ensure that nurses are seen as meaningful users of technology.  Support nurses in moving high-technology care into the hospital setting of the future— the home and community.

TELEHEALTH NURSING

Telehealth Nursing Defined

• Uses telecommunications devices placed in patients’ homes to take their vital signs every day, reminds the patient to take medication and answer simple questions about their condition. It is ideal for both the patient and the health care professionals. • Enable healthcare professionals to have face to face meetings with patients. They can see images and hear patient output as it is occurring or at a later time. For example, telehealth applications enable clinicians to send and listen to a patient's captured heart and lung sounds. • Refers to the use of telecommunications and information technology for providing nursing services in health care to enhance care whenever a physical distance exists between patient and nurse, or between any number of nurses (Skiba, 1998).

What’s Important to Know

• Learning how to use the telehealth medical devices as well as audio, video, and digital software applications over phone, Integrated Services Digital Network (ISDN), or Internet Provider (IP) communication networks • Becoming techno-savvy in using other software applications for entering patient demographic data, saving, sending, and retrieving information to or from the consulting physician or nurse practitioner • Collaborating with information technology staff, biomedical engineers, and telehealth physicians and nurses in one's health care system or hospital as a telemedicine/telehealth/e-health team • Assisting in the development of telehealth guidelines, policies, and procedures • Reviewing and understanding the applicable Health Insurance Portability and Accountability Act (HIPAA) laws with use of telehealth applications • Learning the evolution of telehealth/telemedicine/e-health technologies and how they are being used in healthcare

Terms Related Teleconferencing  Implies that people at different locations have audio and possibly vide contact which is used to carry out telehealth applications.

Video Conferencing

 Implies that people meet face to face and view the same images through the use of telecommunications and computer even though they are not in the same location.

Desktop Videoconferencing  Synchronous or real time encounter that uses specially equipped personal computer with telephone line hook up, DSL or cable connections to allow people to meet face to face and/or view papers and images simultaneously.

Types of Applications

Store and Forward

• digital images, video, audio, and clinical data are captured and stored on the client computer or device; then, at a convenient time, the data are transmitted securely (forwarded) to a specialist or clinician at another location for interpretation

Real-time Telehealth

• This service offers concurrent interactions between patient and doctor. This service includes phone conversations, online communication and home visits. • real-time or live interaction

Remote Patient Monitoring

• This type is also called ‘self-monitoring/testing’. It facilitates the nurse to check a patient remotely using different technological equipments. • devices are used to capture and transmit biometric data

Applications of Telehealth Nursing

Practice • Clinical applications comprise early patient assessments, diagnosis (tele-diagnosis), and consultation (tele-consultation). Supervision of physicians and observation of patient status are likely.

Education • Affords opportunities to educate healthcare consumers and professionals through increased information accessibility via online resources (world wide web, distance learning, and clinical instruction).

Administrative • Administrative uses, for instance, conferences, preparation, utilization and quality appraisal may be offered.

Research • Improved by aggregation of data from numerous sources and harmonization. Advantages of Telehealth Nursing

• Continuity of care • Centralized health records • Incorporation of the healthcare consumer as an active member of the health care team • Collaboration among health care professionals • Improved decision making • Education of healthcare consumers and professionals • Higher quality of care • Removes geographic barriers to care • May lower costs for healthcare • Improved quality of health record

Disadvantages of Telehealth Nursing

• Regulatory barriers • Costs for equipment, network services and training time • Fear of healthcare system changes • Lack of acceptance by healthcare professionals • Lack of acceptance by users • Lack of standards • Homeland security • Mainstream acceptance • Patient safety • Limitations

Technological Development

• Access to training and specialist surgeons for less developed countries • Possible to treat soldiers in the battlefield • Surgical procedures in space • Keep track of your heart beat on your phone and upload it to Facebook/Twitter • If you drop dead, your friends and family will be notified quickly • Robots to serve as companions and provide services for those who are unable to do so themselves

References: Kozier, et. Al. (2008). Nursing Informatics. Fundamentals of Nursing 8th Edition p.144-157 http://www.slideshare.net/thinkrn/nursing-informatics-ana-2008-definition http://www.slideshare.net/bodo-con/chapter-19-10502299