NURSING INFORMATICS

NURSING INFORMATICS (NI)

Introduction

 Dramatic reform and innovation in nursing is needed to create and shape the future of nursing practice.
 Nursing is a dynamic profession with universal needs.
 Computer Technology can transform the nursing profession
 Clinical Information System are common to modern healthcare.

Clinical Information System (CIS)

 A Clinical Information System (CIS) is a computer based system that is designed for collecting, storing, manipulating and
making available clinical information important to the healthcare delivery process.
 A CIS is designed to support clinical nursing practice.
 CIS requires not only understanding of professional nursing practice process but also technology that is application for the
science to function electronically.
 The computer is the most powerful technological tool to transform nursing profession prior to the new century. The
computer has transformed the nursing paper based record to computer based record.
 Computer and internet is very essential for all settings where nurses function.
 Nurses are becoming more computer literate and the nursing profession is implementing practice standards for its clinical
care and data standards for its nursing information technology system. (NI) Nursing informatics is specialist emerged as a
new specialty in the field of professional nursing practice.

Terminologies

 Computer – is a general term referring to information technology (IT) and computer systems. In nursing it is synonymous
into nursing information system (NIS).
 Computers are used to manage information in patient care, monitor quality of nursing care and evaluate care
outcomes.
 Networks with internet are used in communicating and accessing resources and interacting with the patient on the
(WWW).
 Nursing Informatics – refers to the integration of nursing, its information management with information processing and
information technology to support the people worldwide.
 It is a specialty that integrates nursing, computer and information science to manage and communicate data
information and knowledge in nursing practice. (ANA).
Management and processing components may be considered the functional
components of informatics.

Example:

 Data: Yellowish discoloration, Anascarca

 Information: 50-year-old male, day 3 of hospitalization, yellowish
discoloration.
 Knowledge: Pt. demographics, blood tests, integumentary system: anatomy
& physiology, pharmacokinetics of ordered medication.
 Decisions: that guide practice.

Clinical Information System (CIS)

 Clinical Information system - can be used interchangeably with electronic information systems (EHR-S) computerized
patient and electronic medical record.
 It refers to a set of components that form the mechanism by which patient records are created, used, stored and retrieved
usually located within a healthcare provider setting. It includes people, data rules and procedures, processing and storage
devices, communication and support facilities (institute of Medicine, 1991).
 Some of the BARRIERS are:
o Initial cost of acquisition
o Privacy and security
o Clinical resistance
o Integration of Legacy Systems: this poses a stiff challenge to many organizations.
 Some of the BENEFITS are:
o Easy access to patient data
o Structured information
o Improved Drug Prescription and Patient Safety: Clinical Information Systems improve drug dosing and this
leads to the reduction of adverse drug interactions while promoting more appropriate pharmaceutical utilization.

Major Historical Perspectives of Nursing and Computers

i. Six Time Periods

ii. Four Major Nursing eras areas
iii. Standard Initiatives
iv. Significant Landmark Events
v. Major Landmark Milestones Chart
I. Six Time Periods
 Prior to 1960’s – simple beginnings

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o Use of punch cards to store data, and card readers to read computer programs, sort and prepare data for
processing.
o Linked together by paper tape and used teletypewriters to print the output.
o Computers were initially used in health care facilities for basic business office functions.

 1960’s
o Use of computers in healthcare is questioned.
o Studies on computers in nursing is started. Determined how computer technology could be utilized effectively in
the healthcare industry and what areas of nursing should be automated?
o Introduction of cathode ray tubes (CRT) terminals, online data communication, and real time processing added
important dimensions to the computer system.
o Development of Hospital Information System primarily for financial transactions and served as billing and
accounting systems.
o Few HIS’s emerged that documented and processed a limited number of medical orders and nursing care activities.
o However, because of technology limitations, lack of standardization, and diversity of paper-based patient care
records, progress was slow.
 1970’s
o Nurses recognized the computer’s potential for improving the documentation of nursing practice, the quality of
patient care and the repetitive aspects of managing patient care.
o Nurses assisted in the design of HIS.
o Computers used in financial and management functions of patient care systems were perceived as cost-saving
technologies.
o Many of the early systems were funded by contracts or grants from federal agencies.
o Several states and large community health agencies developed their own Management Information Systems (MISs).
 1980’s
o Nursing Informatics is formally accepted as new nursing specialty.
o The need for nursing software evolved.
o It became apparent that the nursing profession needed not only to update its practice standards but also determine its
data standards, vocabularies, and classification schemes that could be coded for the computer-based patient
record systems (CPRSs).
o Nursing documentation
o Emergence of microcomputers/PC. This made computers more accessible, affordable, and useable by nurses and
other health care providers.
 1990’s
o Computer technology became an integral part of the healthcare setting.
o Policies and legislation on promoting computers in healthcare were adopted.
o In 1992, Approval of NI by ANA as a new nursing specialty.
o Required the need for unified nursing standards: language, vocabularies, taxonomies, classification.
o Integration to nursing education and data management in research.
o Laptops/notebooks, LAN, WAN, Internet.
o Dr. Nicholas Davies excellence award is given for excellence in health information technology, this is managed by
HIMSS. (Health Information & Mngt Systems Society).
o By 1995, the internet had moved into the mainstream social milieu with electronic mail (email), file transfer
protocol (FTP), Gopher, Telnet, and WWW protocols which greatly enhanced its usability and user friendliness.
o Computer technology became an integral part of the healthcare setting.
o The “Web” became the means for communicating online services and resources to the nursing community.
o The internet became an integral component of all IT systems, and the WWW used to browse the internet and search
worldwide resources.
 Post 2000
o Growth is reflected in healthcare and nursing with developments such as wireless point-of-care, serious
considerations for open source solutions, regional database projects, and increased IT solutions targeted at all
healthcare environments.
o Clinical Information System became individualized in the electronic patient record (EPR).
o Information technologies continued to advance with mobile technology such as wireless tablet computers,
personal digital assistants (PDAs), and smart cellular telephones.
o The development of voice over Internet protocol (VolP) promises to provide cheap voice communication for
healthcare organizations.
o Internet provided new means of development for clinical applications.
o Telenursing increased in popularity.
o Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted to streamline health care
transactions and reduce cost.
o Recommended that healthcare providers use a provider identification number (PIN) to maintain privacy and
security of patient information.
II. Four Major Nursing Areas
Computers in Nursing – computers can perform a wide range of activities that save time and help Nurses provide quality
nursing care.
1. Nursing Practice
o Computer systems with nursing and patient care data and NCP’s are integrated to Electronic Health Record.
o Need for interdisciplinary EHR was perceived.
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o Introduction of new nursing terminologies were recognized by ANA.
 Nursing Clinical Practice (Point-of-Care Systems and Clinical Information Systems)
o Electronic Medical Record (EMR) and Computer-Based Patient Record (CPR).
o Monitoring devices that record vital signs and other measurements directly into the client record (electronic medical
record).
o Computer – generated nursing care plans and critical pathways.
o Automatic billing for supplies or procedures with nursing documentation.
o Reminders and prompts that appear during documentation to ensure comprehensive charting.
2. Nursing Administration
o Computers linked department together.
o Hospital data, policy and procedures are accessed through computers.
o Hospital process goes on line.
o Internet was utilized by nurses for online research.
 Nursing Administration (Health Care Information Systems)
o Automated staff scheduling
o E-mail for improved communication
o Cost analysis and finding trends for budget purposes
o Quality assurance and outcomes analysis
3. Nursing Education
o Most nursing schools offered computer enhanced courses and distance education
o Campus-wide computer systems became available.
o Computer technology integrated into teaching methodologies
o World wide web facilitates student-centered instructional settings.
 (NE)
o Computerized record-keeping
o Computerized-assisted instruction.
o Interactive video technology
o Distance Learning-Web based courses and degree programs. Universities without walls.
o Internet resources – Continuing education units and formal nursing courses and degree programs
o Presentation software for preparing slides and handouts – PowerPoint and MS Word. Teach courses via web.
4. Nursing Research
o Provides an avenue for analyzing data
o Software’s are available for processing qualitative and quantitative data
o Research databases emerged
o Online access
 (NR)
o Computerized literature searching-CINAHL, Medline and Web sources
o The adoption of standardized language related to nursing terms-NANDA, etc.
o The ability to find trends in aggregate data, that is data derived from large population groups – Statistical Software,
SPS 
III. Standard Initiatives
 Nursing Practice Standards
o ANA – considered as the official nursing organization that contributes in the development and recommendation of
standards of nursing practice worldwide.
o Joint commission on Accreditation of Hospital Organizations (JCAHO) – focuses on the need for adequate records
on patients in hospital and practice of standards in documentation of care.
IV. Significant Landmark Events
 Early conferences, meetings
 Early academic initiatives 1961 Healthcare Information and Management Systems Society was founded
 Initial ANA initiatives 1965 Development of one of the first HIS in California
 Initial National League for 1973 First conference on MIS
Nursing initiatives 1981 First National Conference on Computer Technology in Chicago
 Early international initiatives 1984 First Nursing Computer Journal is published
 Initial educational resources 1989 Graduate program in NI is introduced in Maryland University
 Significant collaborative events 1993 Establishment of electronic library
1995 First International NI Teleconference held in Australia
2002 JCAHO identified Clinical Information System as a way to improve
safety and recommends that hospitals adopt technology.
2003 Health Insurance Portability and Accountability Act was enacted
2004 Establishment of National Health Information Coordinator

Chapter 3 – Electronic Health Record

Historical Background of Electronic Health Records

Introduction

 An electronic record composed of health information regarding an individual patient that exists as part of a complete system
designed to provide access to, and management of, such information. The EHR is developed and managed by the health
facility or provider. The term Electronic Health Record has largely replaced the older “Electronic Medical Record.”

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 It is much more than an electronic replacement of existing paper systems. The EHR can start to actively support clinical care
by providing a wide variety of information services. However, it is hard to understand what information is really important to
clinical care and what is simply occasionally desirable.
 The EHR bring uncountable advantages in primary health care detaching such as the (1) faster access to information, (2) the
updated information, (3) it allows having a clinical process with all the patient clinical information and an (4) easier access to
information (ex: allows the simultaneous access from different locations).
 Recognizable efforts in the development of EHR are distinguished by the Nicholas E. Davis Awards of Excellence Program
whose history describes the improvement of EHR in different settings.

The Nicholas E. Davies Awards of Excellence Program

 The Computer-Based Patient Record Institute (CPRI), founded in 1992, was an organization representing all the stakeholders
in healthcare, focusing on the clinical applications of information technology. It was among the first nationally based
organizations to initiate and coordinate activities to facilitate and promote the routine use of Computer-Based Patient Records
(CPRs) throughout healthcare.
 The CPRI group on CPR Systems Evaluation developed the CPR project evaluation criteria in 1993 which are management,
functionality, technology and impact.
 These became the basis in assessing accomplishments of CPR projects and provided the Foundation of Nicholas E. Davies
Awards Excellence Program.
 The Program was named after Dr. Nicholas E. Davis, an Atlanta-based physician, president elect of the American College of
Physicians, and member of Institute of Medicine (IOM) committee in improving patient records. He was killed in a plane
crash just as the IOM report on CPRs was being released.
 The HIMSS Nicholas E. Davies Awards of Excellence recognize excellence in the implementation and use of health
information technology, specifically EHRs, for healthcare organizations, private practices and public health systems.
 The Davies Award of Excellence is offered in 3 categories: Organizational or Acute Care first offered in 1995,
Ambulatory since 2003, and Public Health initiated in 2004.
 See the list of winners in Page 30. What do you notice with all the winners aside from the fact that all came from the US?
 All have made the EHR a key component of the strategic vision and that they understand that healthcare is an information
business.
 A consistent character of winning organizations is the customer service and constant consideration of the impact of the
system on the end user.
 Getting clinicians to use an EHR as part of their day-to-day work is one of the most significant hurdles that had to be
overcome by the successful Davies applicants.
 Nowadays the Nicholas E. Davies Awards Excellence Program is managed by the Healthcare Information Management
Systems Society.

The Healthcare Information Management Systems Society (HIMSS)

 The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry's membership
organization exclusively focused on providing global leadership for the optimal use of healthcare information technology
(IT) and management systems for the betterment of healthcare.
 Vision – Advancing the best use of information and management systems for the betterment of health care.
 Mission – To lead change in the healthcare information and management systems field through knowledge sharing,
advocacy, collaboration, innovation, and community affiliations.
 HIMSS Objectives:
o Promote the vision of EHR systems through concrete examples
o Understand and share documented value of EHR systems
o Provide visibility and recognition for high impact EHR system
o Share successful EHR implementation strategies
o Encourages and recognizes excellence in the implementation of EMR/EHR systems: Implementation, Strategy,
Planning, Project Management and Governance– Strategy

Difference of Nicholas E. Davies Excellence Awardees

 Nicholas E. Davis Excellence awardees shows differences that make one distinct Who May Apply?
from the other  Healthcare organizations
 Variable years spent in EHR program development.  Primary care
 Different external agenda and societal challenges.  Public health
 Application of new technologies and techniques.

Application and Assessment Process

Nursing Informatics

 is a specialty that integrates nursing science with multiple information management and analytical sciences to identify,
define, manage, and communicate data, information, data, information, knowledge, and wisdom in nursing practice. NI
supports consumers, patients, nurses, and other healthcare professionals in their decision-making in all roles and settings to
achieve desired outcome. This support is accomplished through the use of information structures, information processes, and
information technology.
 Is a specialty that integrates nursing science, computer science, and information science to and information science to
manage and communicates data, information, and knowledge in nursing practice.

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 It facilitates the integration of data, information to support patients, nurses, and other providers in their decision making in all
roles and settings. This support is accomplished through the use of information structures, information processes, and
information technology.

Nursing Informatics Specialist

 Is responsible for providing clinical information and data analysis for effective patient care and monitoring.
 Works with computer systems, data and information and information analysis systems such as a statistical information
system to ensure optimal healthcare is provided.

Specific Role of Nurse Information Specialist

 Employs informatics theories, concepts, methods, and tools to analyze information and information system requirements.
 Design, select, implement, and evaluate information systems, data structures, and decision support mechanisms that support
patients, nurses, and their human-computer interactions within health care contexts.
 Facilitates the creation of new nursing knowledge.

What do we need to achieve nursing informatics?

 Nursing science
 Information science
 Computer science
 Information is doubling every 5 years, if not tripling in quality and quantity
 INFORMATION is POWER
 Technology facilitates the creative process in nurses, affording amazing vehicles for, PATIENT EDUCATION, TEACHING
and LEARNING.
 Provides health promotion and prevention in a global scene.
Nursing Practice will be revolutionized and we will truly be a profession of nurses with our own classification systems,
bibliographic systems, and payment systems.

What is Informatics?

 Combination of the terms information and automatic/automation which means automatic information processing.
 A science that combines the domain science, computer science, information science and cognitive science.

Rognehaugh

 “the use of any computer and information technologies that support any nursing function carried out by nurses in the
performance of their duties”

Hannah (1985)

 “use of information technologies in relation to those functions, within the purview of nursing that are carried out by nurses
when performing their duties”

Graves and Corcoran (1989)

 “a combination of computer science, information science and nursing

science designed 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.”

Hebda (1998)

 Defines nursing informatics as “the use of computers technology to support nursing, including clinical practice,
administration, education, and research.
2. Schwirian’s Model (1986)
 Patricia Schwirian – proposed a model intended to stimulate and guide systematic
research in nursing informatics in 1986.
 The framework that enables identification of significant information needs, that
can foster research.
3. Turley’s Model (1996)
 Nursing informatics is the intersection between the disciple-specific science
(nursing) and the area of informatics
 Core components of informatics
 Cognitive science
 Information science
 Computer science

Origins of Nursing Information System

 1977
o The first Nursing Information System Conference was held in the United
States
o Here nurses adapt computer processes to enhance client care, education,
administration and management, and nursing research.
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 October 1995
o The first ANA certification examination in Nursing Informatics was given.
o This creates the Nurse Informaticists – they are responsible for interfacing between the client care and information
technology departments and assisting with the development, implementation and evaluation of initiatives in clinical
information system.
 1999
o A study was formed to identify International Standards for health information and their adaptability in the
Philippines referred to as “Standards of Health Information in the Philippines, 1999 ver. (SHIP99).
 2003
o Master of Science in Health Informatics was proposed to be offered by UP-Manila College of Medicine (major in
medical informatics) and the College of Arts and Science (major in bioinformatics) and was later approved to be
offered starting academic year 2005-2006.
 2006
o Creation of TIGER (Technology Informatics Guiding Educational Reform)
o Created to identify knowledge/information management best practices and effective technology capabilities of
nurses.
 2008
o Nursing Informatics course in the undergraduate curriculum was defined by the Commission on Higher Education
(CHED). Memorandum Order 5 Series of 2008, later revised and included as Health Informatics course in CHED
Memorandum Order 14 Series of 2009, and first implemented in the summer of 2010.
 2009
o Mr. Kristian R. Sumabat and Ms. Mia Alcantara-Santiago, both nurses and graduate students of Master of Science in
Health Informatics at the University of the Philippines, Manila began drafting plans to create a nursing informatics
organization .
 2010
o They began recruiting other nursing informatics specialists and practitioners to organize a group which later became
as the Philippine Nursing Informatics, a sub-specialty organization of PNA for nursing informatics.

Framework of Nursing Informatics

 Data – discrete entities that are described objectively without interpretation.

 Information – as data, however is interpreted, organized or structured.
 Knowledge – as information that has been synthesized so that interrelationships
are identified and formalized… this results to decisions that guides practice…
 Health and nursing information science is the study of how health care data is
acquired, communicated, stored, and managed, and how it is processed into
information and knowledge. This knowledge is useful to nurses in decision-making
at the operational, tactical, and strategic planning of levels of health care.

Computer System

1. Computer Hardware
2. Computer Software System
3. Open Source and Free Software
4. Data Assessment
5. Personal, Professional and Educational Informatics

Computer System

 A network of computers, users, programs and procedures in an organization –

assists the health care team with decision-making and communication.
 Two (2) most common types Computer System:
1. Management Information System
2. Hospital Information System

Hospital Information System (HIS)

 An MIS that focus on the types of data needed to manage client care activities
 Provides people with the data they need to determine appropriate actions and control them.
 Evolve in HMIS

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Management Information System (MIS)

 Designed to facilitate the structure and application of data used to manage an organization or department.
 Provides analyses used for strategic planning, decision-making and evaluation of management activities.

Computer Hardware INPUT Keyboard Scanner Joystick

Optical pen Barcode reader
 Hardware is the physical part of the computer and its associated
OUTPUT Head phones Inkjet printer Screen
equipment. Computer hardware cam comprise many different
Head set Plotter
parts, these include: Laser printer Speakers
1. Input devices BOTH Digital camera Webcam
2. Output devices (input & Pendrive Fax
3. Central Processing Unit (CPU) output) Touch screen Modem
 Read-only memory (ROM) is permanent; it remains when the CD/DVD
power is off. A start-up instruction for the computer is an
example of ROM.
 Random access memory (RAM) is a temporary storage area for program instructions and data that is being processed; it is
only active while the computer is turned on. (Located on the motherboard not part of CPU).
 Control Unit: manages instructions to other parts of the computer, including input and output devices “traffic cop”.
 Solid-state drive (SSD) is a solid-state storage device that uses integrated circuit assemblies to store data persistently,
typically using flash memory, and functioning as secondary storage in the hierarchy of computer storage.

Secondary Storage

 Provides space to retain data in an area separate in an area computer’s memory after
the computer is turned off, these include; hard disk drives, floppy disks, tape, zip
drives, optical drives and CD – ROM drives. And also there are many storage drives
that are available like flash drive, external hard drive etc.

Flash CD=R Smart Media Smart cards Pendrive

Floppy Disk DVD=RW Removable hard-drive Online storage site Blu-ray disc
Zip Disk DVD=R Microdrive PC card Magnetic tape
CD=RW Storage Type Memory Stick HDD SSD

Data Assessment

 The Science of Nursing Informatics

 Data – discrete entities that are described objectively without interpretation.
 Information – as data, however is interpreted, organized or structured.
 Knowledge – as information that has been synthesized so that interrelationships
are identified and formalized. Resulting in decisions that guide practice.
 Example: The collection of individual data element “Raw Data” the transition of
raw data to knowledge is a three-phased process.

Three-Phased (3) Process

 “Nursing Data” is the raw data such as client name, age, gender, diagnosis when
the nurse forms a relationship between the raw data elements” form fully picture of
client’s clinical status this is called “Nursing Information” then the nurse acts on
this information by formulating a set of interventions to deal with the particulars of
a specific client care situation. Those are in a form that can be subjects to analysis
and interpretation. Nursing information readily lends itself to archiving or storage
in computer databases that allow rational grouping of nursing information then
allows for aggregation of information and the systematic study of nursing related
phenomena. Sets of nursing information that conform to theoretical and conceptual
frameworks are known as “Nursing Knowledge”.

Nursing Clinical Practice (Point-of-Care Systems and Clinical Information Systems)

 Work lists to remind staff of planned nursing interventions

 Computer generated client documentation
 Electronic Medical Record (EMR) and Computer-Based Patient Record (CPR)
 Monitoring devices that record vital signs and other measurements directly into the client record (electronic medical record).
 Computer - generated nursing care plans and critical pathways
 Automatic billing for supplies or procedures with nursing documentation
 Reminders and prompts that appear during documentation to ensure comprehensive charting

Nursing Administration (Health Care Information System)

 Automated staff scheduling

 E-mail for improved communication
 Cost analysis and finding trends for budget purposes
 Quality assurance and outcomes analysis

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Personal, Professional and Educational Informatics

 Scope of Nursing Informatics

P - Practice
E - Education
R - Research
A – Administration

Nursing Informatics and Education

Teaching and Learning

 Computer enhances both students and faculties in 4 ways:

1. Literature
2. Computer assisted instruction
3. Classroom technologies
4. Distance learning strategies
 Literature Access and Retrieval
o Continuous updated cumulative indexes of related materials can be searched electronically in a fraction of the time.
o Once a list of search matches is displayed on the computer screen, users can select all of certain citations and either
print them or store.
 Computer Assisted Instruction (CAI)
o Software programs that cover topics from drug dosage calculations to ethical decision making are classified
according to the format: tutorial, drill and practice, simulation, or testing.
o Diagrams, graphics, animations, video, and audio via CD-ROMS or via the internet.
o Allow almost instant access to any section of the program and can be designed to branch to different sections
depending on user’s responses.

 Classroom technology
o Electrical outlets for students to plug in laptops and wirings (Wi-Fi) for network and internet access.
o “Smart classrooms” with projectors that display the content of computer screens and document cameras that display
objects and print materials for the entire classroom.
o “Clickers” use of audience response systems and class-capture systems that record and post lectures and visuals to
the internet.
o Tools ranging from systems that use computers and small devices to provide skills practice (task trainers)
o High fidelity Human Patient simulators with the ability to breather, speak, and display digital readouts that reflect
the impact of nursing interventions.
 Distance learning
o Educational opportunities delivered under situations in which the teacher and the learner are not physically in the
same place at the same time.
o Asynchronous – when the persons involved are not interacting at the same time.
o Synchronous – when teachers and students are communicating simultaneously.
o Faculty can post syllabi, handouts, assignments, and examination in individual course shells, and students can
submit papers and hold discussion online.
o Faculty and students can create avatars—virtual self to navigate through simulated worlds and communicate using
audio-visual lectures, discussion and posters.
 Testing
o Computers are ideal for conducting types of learning evaluation.
o Large banks of potential items can be written and the computer generates different exams for each student
depending on the selection criteria designated by the faculty.
o The computer determines if the applicant passed the examination by using a scoring algorithm that ensures all
required competencies have been evaluated fairly.
 Student and Course Record Management
o Computers are useful for maintaining results of students’ grade or attendance using spreadsheets.
o Programs can calculate percentages, sort student scores in order, and print results for the students and the faculty.
o Data warehousing – the accumulation of large amounts of data that are stored over time and can be examined for
output in different types of reports (charts and tables).
 Computer System
o A network of computers, users, programs and procedures in an organization – assists the health care team with
decision making and communication.
o Two (2) most common types of Computer System
1. Management Information System (MIS)
2. Hospital Information System (HIS)

Information Technology System Applicable in Nursing Practice

i. Hospital/Critical Care Applications

ii. Community Health Applications
iii. Ambulatory Care Systems
iv. Emergency Preparedness and Response
v. Administrative Assistive Devices and Workplace Technologies
vi. Telehealth

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I. Hospital/Critical Care Applications
 Critical Care Nursing
o Is an area of expertise within nursing that focus specifically with human responses to life threatening problesms.
 Critical Care Nurse
o Is responsible to ensure that critically ill patients are seriously conditioned individuals
o Ensure that families of the medically ill patients should receive optimal care.
o Rely upon a dedicated knowledge, skills and experience and of course automated system of support and intelligent
system to provide care to patient and families and create environments and families and create environments that are
healing, compassionate and caring.
 Critical Care Applications
o Areas where patients require complex assessment, high-intensity medication, continuous therapy and interventions,
and unrelenting nursing attention and continuous watchfulness.
 Critical Care Information System
o Provide real-time resource utilization data and management of information and access critical information and
access critical care areas through the integration of the care areas through the integration of the medical f medical
facilities in the critical care or intensive care
o Enables the electronic collection of hospital and patient-specific critical care data of the entire patient in the critical
care areas which can be processed to create a patient profile which generate real time and historical report on
indicators including bed ding bed occupancy, delayed discharges, occupancy, delayed discharges, readmission rates,
and outcomes.
o Automated collection and management of medical info medical information will become the important task of the
critical care information system.
III. Ambulatory Care
 Covers a wide range of health care services that are provided for patients who are not admitted overnight to a hospital.
 These services are performed at outpatient clinics, urgent care centers, emergency rooms, ambulatory or same-day surgery
centers, diagnostic and imaging centers, primary care and imaging centers, primary care centers, centers, community health
centers, occupational health centers, mental health clinics, and group practices.
 Ambulatory Care Systems
o Provides automated processing of data and information such as allergies and medical alerts, patients accounting
system such as charging, billing, discounts and concessions, diagnostics imaging treatments, and etc.
o With this system, the patient waiting time is optimized through effective queue. management.
o It involves one-time registration required per visit. It also facilitates the management of doctor’s schedule.

Informatics Applications in Evidence-based Nursing Practice

i. Computer Generated Nursing Care Plans

ii. Critical Pathways
iii. Clinical Guidelines
iv. E-journals

Need for Nursing Informatics

 “In the current Information Age, the doubling of knowledge every five years and the increased specialization of knowledge
make it imperative that nurses have access to the latest scientific information to assist in the delivery of high quality care,”
(Hudgings, 1992,).

Policies, Guidelines and Laws in Nursing Informatics

Intellectual Property

 World Intellectual Property Organization (WIPO) was established by the WIPO Convention in 1967.
 The WIPO is a specialized agency of the United Nations.
 It promotes the protection of Intellectual Property throughout the world.
 Its headquarters are in Geneva, Switzerland.
 World Intellectual Property Day – April 26. On World

What is “Intellectual Property?”

 Intellectual Property is a property that arises from the human intellect. It is a product of human creation.
 Intellectual Property comprises of two (2) distinct forms:
1. Literary and Artistic Works
2. Industrial Property

“Literary and Artistic Works”

 They are books, paintings, musical compositions, plays, movies, radio/TV programs, performances, and other artistic works.
 How are they protected?
o Protected by “COPYRIGHT”

Intellectual Property Code of the Philippines, Republic Act No. 8293

 The state recognizes that an effective intellectual and industrial property system is vital to the development of domestic and
creative activity, facilitates, transfer of technology, attracts foreign investments, and ensures market access for our products.

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 It shall protect and secure thee exclusive rights of scientists, inventors, artists and other gifted citizens to their intellectual
property and creations, particularly when beneficial to the people, for such periods as provided in this Act.
 The State shall promote the diffusion of knowledge and information for the promotion of national development and progress
and the common good.

Copyright Law of the Philippines, Republic Act No. 8293

 Took effect on January 1, 1998, under the presidency of Fidel V. Ramos.

 A copyright is the legal protection extended to the owner of the rights in an original work.
 In the Intellectual Property (IP) Code of the Philippines, literary and artistic works include books, writings, musical works,
films, painting and other works including computer programs.

Copyrights

 Intangible property right granted by federal statute to the author for life plus 70 years.
 Automatic protection.
 Work must be original and “fixed in a durable medium.” Ideas are not protected, but the expression of an idea is.
 Copyright Infringement
o Form or expression is copied (does not have to be in its entirety).
o Penalties, damages and criminal action are possible.
 Exception: “Fair Use”
o Certain persons or organization can copy materials without penalty (e.g., education, news, research).
 Copyright Protection for Software

Copyrights in Digital Information

 Digital media can easily be copied

 Copyright Act of 1976:
o Copy of a program into RAM is infringement.
o Revision or re-sale of freelance authors works can be infringement.
 MP3 and File-Sharing
o Napster case
o P2P sharing, distributed network

“Industrial Property”

 Industrial Property describes physical matter that is the product of an idea or

concept for commercial purposes.
 How are they protected? By…
o Patented objects
o Trademarks
o Industrial Designs
o Trade Secrets
o Layout-designs
o Geographical Indications

Intellectual Property Rights Under the IP Code

 The intellectual property rights under the IP Code are as follows:

1. Copyright and related rights
2. Trademark and service marks
3. Geographical indications
4. Industrial design
5. Patents
6. Layout-designs (topographies) of integrated circuits
7. Protection of undisclosed information Major Types of IP
 The agency of the government in charge of the
implementation of the IP Code is the
Intellectual Property Office, which replaced
the Bureau of Patents, Trademarks and
A symbol, logo
Technology Transfer. It is divided into Functional and
Purely Artistic Works sound, color,
six (6) bureau, namely: Technical Inventions
etc.
1. Bureau of Patents
2. Bureau of Trademarks
3. Bureau of Legal Affairs Copyright Act, 1957
Patents Act, 1970 Amended in 1982, Trademark Ac
4. Documentation, Information and Technology Amended in 1999 & 1984, 1992, 1994 & Amended in
Transfer Bureau 2005 1996 & 20
1999
5. Management Information System and EDP Bureau
6. Administrative, Financial and Personnel Services Bureau

Intellectual Property Law

 Deals with the rules for securing and enforcing legal rights to inventions, designs, and artistic works.
 Give incentive for people to develop creative works that benefit society, by ensuring they can profit from their works without
fear of misappropriation by others.
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 Article 1. Section 8 of the US Constitution gives Congress express authority to grant authors and investors exclusive rights to
their creation.
 Section 8, gives Congress the power to regulate interstate and foreign commerce, providing further support for its rights to
legislate in this area.
 Intellectual property laws passed by Congress are administered by two government agencies, the US Patent and Trademark
Office, and the US Copyright Office.

Patents

 It is covered under the Act called the Patents Act, 1970 [Amended by Patents Act, 2005]
 It extends to the whole of India.
 It shall come into force on such date as the Central Government may publish, by notification in the Official Gazette.

Patents

 Definition: A patent describes an invention for which the inventor claims the exclusive right.
 Invention patentable if…
 New (Novel)
 Useful
 Not obvious
 Pertains to patentable subject matter

Patentable Subject Matter

 Invention
o Relates to a process or product or both
o Involves an inventive step
o Be capable of industrial application
o A machine

Life and Duration

 Term of the patent is 20 years from the date of filing for all types of inventions.
 Priority date – first to file
 The date of patent is the date of filing the application for patent.
 The term of the patent is counted from this date.

Is a patent granted in one country enforceable in other countries?

 No, there is nothing like a global patent or a world patent. Patent rights are essentially territorial in nature.
 Granting a patent in one country of the Union does not force other countries to grant the patent for the same invention.
 The refusal of the patent in one country does not mean that it will be terminated in all the countries.

Trademark

 It is covered under the Act called the Trade Marks Act, 1999.
 The Act came into effect on September 15, 2003. It replaced the Trade and Merchandise Marks Act, 1958.
 It extends to the whole of India
 It shall come into force on such date as the Central Government may publish, by notification in the Official Gazette.

Trademarks

 Trademark
o A symbol, logo, word, sound, color, design, or other device that is used to identify a business or a product in commerce.
o Different symbols are:
o ™ - Intent to use application filed for product
o Intent to use application filed for services
o ® - Registered trademark

Registration Procedure

 Application for search

 Application for registration
 Examination of trademark
 Advertisement of trademark
 Filing of opposition
 Certificate issued

Duration and Fees of Trademark

 Trademark is valid for 10 years from the date of application which may be renewed for further period of 10 years on payment
of prescribed fees.
 Service mark Rights are reserved exclusively for owners for 17
years and it can also be renewed.

Applicability of Trademark

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 A trademark is a sign used on, or in connection with the marketing of goods or services.
 “Used on” the goods mean that it may appear not only on the goods themselves but on the container or wrapper in which
the goods are when they are sold.
A. Set apart from the surrounding text.
B. Specify font, size, proportion and placement
C. Do not change spelling

Original

 The term original in the copyright law means that the work originated with the author.
 There is no requirement for novelty or uniqueness as there is in patent law.
 Copyright law protects the expression of an idea. Not the idea itself.

What is COVERED by copyright What is NOT COVERED by copyright

Literary Ideas
Films Facts
Dramatic Recipes
Musical Works lacking originality (e.g. The phone book)
Artistic Names, titles, or short phrases
Sound Recording

Registration Procedure

 Register a copyright by completing a simple application form, along with the appropriate fee.
 Need not send a copy of your work.
 It may appear with the same title, but if each work has been created independently, each will have its ow copyright
protection.

Duration of Copyright

 Copyright lasts for the…

o Author’s lifetime + 50 years from the end of the calendar year in which the author dies.
o 50 years for films and sound recordings
o 25 years for typographical arrangements of a published edition.
o Copyright protection always expires on December 31 of the last calendar year of protection.

What is “Fair Use?”

 Gives permission to use copyrighted materials if certain criteria are met.

 Protects freedom of speech.
 Promotes public benefits like education.

Beware of the “Fair Use Excuse”

 Never assume that your use falls under the fair-use exception.
 “Saving money” is not a sufficient excuse.
 Laziness can be a trap.

How much can I use?

 Photos and images – up to 5 works from one author; up to 10% or 15 works, whichever is less, from a collection.
 Database information – up to 10% or 2500 fields or cell entries, whichever is less.

What constitutes Infringement?

 Any reproduction, use, distribution, performance, etc. of the work without the permission of the owner.
 An identical or substantial similar reproduction is also covered.
 Infringement – Damages – Injunction

Remedies for Patent Infringement

 A suit can lie in the District or High Court.

 It may issue an injunction either to prevent the infringer from any further use and awards damages to the patent owner or
will pay the patent owner royalties for further use.

Remedies for Trademark Infringement

 A suit can lie in District or High Court

 Punishment extends from 6 months to 3 years.
 A permanent ban on engaging in commercial activities.

Remedies for Copyright Infringement

 A suit can lie in the district court or in a high court u/s 63 of the copyright act, 1957.
 Punishable with imprisonment up to 3 years and fined as per the claims.

“…but I didn’t know!”

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 Called “Innocent Infringement”
 Occurs when infringer was unaware that things were protected.
 No excuse if work properly displays…
o “Patent”
o Trademark symbol:
o Copyright notice:

Types of Right Under the Law of Copyright

1. Economic Rights
 Replication of the work, or a portion of the work.
 Transformation or dramatization of the original work.
 The first public distribution of the original work and each copy of the work.
2. Moral Rights
 Require authorship of the work attributed to him or her, meaning that the author may require that his or her name be
displayed in a prominent fashion on a copy or public distribution or use of the work.
 To make any transformation or adjustment to the work, or withhold it from publication.
 To oppose any and all mutilation or any other derogatory action to the work which could potentially be
detrimentally to the author’s honor and reputation.

3. Resale rights
 The author and his or her heirs have the inalienable rights to partake 5% of the proceeds of the sale or lease of his or
her original work (painting, sculpture, manuscript, composition). This alienate right is in effect during the lifetime of
the author, and for fifty years after his or her death.
4. Related Rights
 RELATED RIGHTS – are the rights of those whose help the author avails of in order to assist him in producing his
work and distributing this work to the public. These rights are also referred to as “neighboring rights” and include
the following:
o Rights of performers
o Rights of producers of sound recordings
o Rights of broadcasting organization

Privacy of Personal and Public Domains

 A network domain is an administrative grouping of multiple computer networks or host within the same infrastructure.
 Domains can be described using a domain name; domains which need to be accessible from the public internet can be
assigned a globally unique name with the Domain Name System (DNS).

Public Domain and Social Networking

What is Social Network?

 “A social network is a social structure made up of a set of actors (such as individuals or organization) and the dyadic ties
between these actors.” – Wikipedia.org
 Six Degrees of Separation
o Everyone on Earth is separated from everyone else by no more than six intermediate personal relationships.
 Vehicles of social networking
o SMS
o Email
o Micro-blog
o Blog
o Webcasting
o Live Streaming
o Share and Ping-back
o Follow, +1, Like

Broadcast Media Turns Social

 TV offers networking capabilities ELEMENTS OF SOCIAL CONTROL

 Amplify your message Domain Rules Sanctions
 Viewer to contributor Individual Ethics and Netiquette Self-restraint
 Power and profitability through Company or Portal User agreement and Moderation by
strong communities for fans and Reminder by software code Administrators and
Software code
consumers.
Social Situational and peer group Shaming, blaming and
 Most active groups are the ones that
Environment norms exclusion
achieve many-to-many conversations. Organization Organizational rules Organizational
Water-Cooler (Social) Effect enforcement
Government Law State enforcement
 Socializing around a focal point International Treaty International enforcement

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 Split time between the computer screen and the big-screen TV
 View and engage online simultaneously

[BLANK – slide 158 – 163]

NETIQUETTE

Ten (10) Rules of Netiquette

 There are Ten rules of Netiquette that everyone who goes online should follow.
 You should remember them every time you go online.
 Netiquette is a set of rules for behaving properly online.
 Remember the ten rules of netiquette and the ten commandments for computer ethics while you are online and you will not
have any problems.
 The ten rules are as follows:
1. Remember the Human
o You need to remember that you are talking to a real person when you are online.
o The internet brings people together who would otherwise never meet.
o Remember this saying when sending an email: “would I say this to the person’s face?”
2. Adhere to the same standards online hat you follow in real life
o You need to behave the same way online that you do in real life.
o You need to remember that you can get caught doing things you should not be doing online just like you can in real
life.
o You are still talking to a real person with feelings even though you can’t see them.
3. Know where you are in cyberspace
o Always take a look around when you enter a new domain when surfing the web.
o Get a sense of what the discussion group is about before you join it.
4. Respect other people’s time and bandwidth
o Remember people have other things to do besides read your email. You are not the center of their world.
o Keep your post and emails to a minimum by saying what you want to say.
o Remember everyone won’t answer your questions.
5. Make yourself look good online
o Remember to always check your spelling and grammar before posting.
o Always know what you are talking about and make sense saying it.
o Be polite and pleasant to everyone.
6. Share expert knowledge
o Ask questions online
o Share what you know online
o Post the answers to your questions online because someone may have the same question you do.
7. Help keep flame wars under control
o Netiquette does not forbid flaming.
o Netiquette does however forbid people who are flaming to hurt discussion group by putting the group down.
8. Respect other people’s privacy
o Do not read other people’s mail without their permission.
o Going through other people’s things could cost you your job or you could even go to jail.
o Not respecting other people’s privacy is bad netiquette.
9. Don’t abuse your power.
o Do not take advantage of other people just because you have more knowledge or power than them.
o Treat others as you would want them to treat you if the roles were reversed.
10. Be forgiving of other people’s mistakes
o Do not point out mistakes to people online.
o Remember that you were once the new kid on the block.
o You still need to have good manners even though you are online and can’t see the person face-to-face.

Email etiquette

 There are etiquette rules for email messages also. They are as follows:
1. Check your email daily
2. Delete unwanted messages
3. Keep messages in your box to a minimum
4. Mail messages can be downloaded and saved for future references.
5. Never assume that your email can be read by no one but yourself.
6. Remember there will always be lurking around online.

Ten Commandments of Computer Ethics

 Ten commandments taken from the user guidelines and netiquette by Ariene Rinaldi. Ten commandments are as follows:
1. Thou shalt not use computer to harm people.
2. Thou shalt not interfere with other people’s work.
3. Thou shalt not snoop around other people’s files.
4. Thou shall not use a computer to steal.
5. Thou shalt not use a computer to bear false witness.

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6. Thou shalt not use or copy software.
7. Thou shalt not use other people’s computer resources.
8. Thou shalt not appropriate other people’s intellectual output.
9. Thou shalt think about the social consequences of the program you write.
10. Thou shalt use a computer in ways that show consideration and respect.

Internet Etiquette

 Know your manners when using

DO DON’T
technology.
o Respect other people’s privacy o Name-call or express offensive
 Ten Basic rules of netiquette or internet
o Verify facts before reporting opinions
etiquettes
o Check messages and respond o Post private or embarrassing
1. Real people take priority
promptly images or comments
2. If you wouldn’t say it to someone’s o Exclude people or talk behind their
face, don’t say it online back
3. If you wouldn’t show it in public, don’t
share it online
4. Don’t exclude your audience
5. Don’t “friend “them “unfriend “people
6. Don’t overload system resources with enormous files
7. Respect people privacy
8. Don’t repost without checking the facts
9. Check and respond to email property
10. Update online information that people depend upon.

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