shabelly.

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06 – Data and Data PRACTICE of nursing informatics was included

for the FIRST TIME in the 2008 American
Processing Nurses Association (ANA) Scope and
NCM 110: Nursing Informatics Standards of Practice for Nursing Informatics
(American Nurses Association, 2008).
Key Words
o Big data
o Curating
o Dashboard
o Data
o Database
o Data analytics
o Data lake
o Data mining
o Data warehouse
o Information
o Knowledge
o Knowledge discovery in databases
(KDD)
o Wisdom

Generating Data
Introduction
In 2012, the White House released a document Data Definition - Context
titled FACT SHEET: Big Data Across the
Federal Government that lists big data projects Data is “a fact represented as an ITEM or
that the Federal Government has undertaken EVENT out of context” (Mullins, 2013, p. 686).
(The White House, 2012). Data alone DO NOT provide insights. As noted
in the previous section, without context it is
A list of the KEY legislative initiatives includes DIFFICULT to make judgments on data alone.
the following:

o 21st Century Cures Act (Cures Act) Data States

o The Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA) When DISCUSSING digital data, it is important
o The Health Information Technology for to discuss the three states of data—data AT
Economic and Clinical Health (HITECH) REST, data IN MOTION, and data IN USE
Act of 2009 (Rouse & Fitzgibbons, 2019).
o Section 618 of the Food and Drug
Administration Safety and Innovation Act
(FDASIA) of 2012 Data Sources – Including Patient-
o The Health Insurance Portability and
Generated Data and Population
Accountability Act (HIPAA) of 1996
o AFFORDABLE CARE Act of 2010 Health Data
Data have always been IMPORTANT part of
healthcare. BEFORE digitization, handwritten
The Nelson Data to Wisdom Continuum nurses’ and doctors’ notes, charts, and drawings
provided insight when making decisions about
The Data, Information, Knowledge and
health and health trends.
Wisdom Model (Nelson D-W) depicting the
megastructures and concepts underlying the
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Data Input Operation Veracity

Since data COME from a variety of sources and One of the potential pitfalls of relying on big data
devices, it is important to note that ONE of the is that the veracity of the data is OFTEN not
most important aspects of data processing is verified.
to CAREFULLY define the healthcare
processes that RELATE to the input of data. Value
The FIFTH aspect of big data is clinically
relevant data that bring value to BOTH the
patient and healthcare systems.

Variability
ADDRESSES the extent and speed that the
structure of the data are changing as well as
the frequency of the CHANGE.

Big Data
The term Big Data has gained increasing
recognition over the last decade. For several
decades, NURSES have collected and stored Data Repositories (Storing Data)
data, but the ability to analyze or “do” anything
with data has NOT COME to fruition until Database Management Systems
recently.
A database by definition is an organized
COLLECTION of data. A database management
Volume system (DBMS) is software that contains the
When speaking about the volume of big data, this database as well as a collection or set of
means the amount of data CREATED on a programs for ACCESSING and PROCESSING
given day. these data in the database thereby IDENTIFYING
relationships between the data.

Variety Advantages of Database Management Systems

A SECOND aspect of big data is the variety of The main advantage of a DBMS is that it
data being produced and combined in order to IMPOSES a structure onto the data that allows
GAIN insights. interaction between the end user and the data.

Velocity Client-Server Configuration

The THIRD aspect of big data as defined by IBM Because a DBMS is a software product that
is the velocity of data. allows you to structure and organize your data,
there are SEVERAL organizational systems
that developers have developed.

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Entity Relationship Model – In an Entity

Relationship (ER) Model the database
FEATURES the organization of the data around
entities (Mullins, 2013).

Graph-Oriented Object Data Model – In a

Graph-Oriented Object Data (GOOD) Model the
underlying organization is NOT a system of
Cloud vs. In-house: tables and relationships, but rather a graph
representation of the objects in the database.
• One of the BIGGEST developments in
the recent past is cloud computing.
Data Warehouses
Distributed vs. Centralized:
Purpose of a Data Warehouse
• One of the DECISIONS that needs to be
made is whether the database is going The purpose of a data warehouse is to PROVIDE
to be distributed or centralized. a PLACE to store multiple forms of data in a
lightly summarized way.

Structure of DBMS
Function of a Data Warehouse
In general, a DBMS consists of data that
designers STRUCTURE into tables and JOIN by The function of the data warehouse is to serve as
relationships a central information repository. In TRUE
DATA warehouse situations, once the data are
curated and stored in the data warehouse, there
is NO NEED to search for data anywhere else.

Other Types of Storage

Relational Database Models – is still the MOST Data Marts: A data mart is a DBMS that is for a
popular form of DBMS, but Non-Relational single unit of work and may contain a subset of
Databases (e.g.MpSQ) are on the rise. data STORED in a warehouse.

NoSQL Database Models – is an agile system Data Lakes: A data lake is a freer form of a
that EASILY PROCESSES unstructured data DBMS where the STRUCTURE of the data is
and semi-structured data. loose and varied including structured, semi-
structured, and unstructured data.

Data Stores: Lastly, a data store is a generic

term used to describe a DBMS that LUMPS
several diverse data sources together.

Selecting a Data Storage Repository

When selecting any form of a DBMS it is
important to REALIZE that with the advent of
cloud computing there are literally HUNDREDS
of different configurations, but there are DBMS
criteria that might help when choosing a system
(Wasson, Wilson, Buch, Salomaki, & Lee, 2018).

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Compare & Contrast Auditing Aspects of Data

• Another useful feature of DBMSs is the
ability to pull reports FOR auditing
Most modern-day systems are client server
purposes.
systems. This allows for a shared DBMS that
many users can access.

When thinking about which SOLUTION to Retrieving Data (Producing Information)

choose, it is important to consider several things,
some of which are as follows:
Retrieval Examples
Network configuration: What type of network • One example of portals is a patient
will the system be running on? For example, local portal that allows a patient to GO IN and
area network (LAN), wide area network (WAN), VIEW his or her medical data on the
and wireless local area network (WLAN). Internet or through another type of
application.
Type of data being stored: If there will be a lot
of medical images, videos, or sounds, it is SQL T
IMPORTANT to realize that these need a lot of • The method of data retrieval is often
space. through the use of SQL queries. SQL
(see-kwel) stands for Structured Query
Amount of data: How much data are there? If
there is a large amount of data, a system that
allows for FASTER RETRIEVAL from the system
may be necessary.

Systems interoperability: Are there

REQUIREMENTS that the system interface with
another system?

Budget considerations: How much money is Basic SQL Structure

being dedicated to the database project? • Basic SQL commands take the form of an
ACTION being taken on a table WHERE
a piece of criteria is constrained in a
Access DEFINED way.

SQL Functions
Lastly, another consideration discussing
• In the previous example, the SELECT
database management systems is WHO will
function was used
need access to the data.

Interpreting Data
Curating Data
(Producing Knowledge & Making Decisions)
Ensuring Data Quality
• One must take into account several Data Analysis and Presentations
aspects when thinking about the quality • Once data is STORED and in a
of data. retrievable form, it is important to
produce knowledge and present the
Interoperability (Moving Data between data in a form for decision-making.
Systems)
• One of the biggest advantages of the Analytics
data movement, as well as the use of • Once the data has been stored, curated,
DBMS IN GENERAL, is the ability to and retrieved, it is then the
export data from one system and input responsibility of the end user to go
it into another.
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through and PERFORM ANALYTICS on TRENDS or by SUPPORTING the

the data. decision of the professional.

Using Knowledge (Producing Wisdom)

The end goal of data and data processing is to
gain wisdom in order to make BETTER
DECISIONS that result in IMPROVED patient
outcomes, patient centric care, and value-based
healthcare. By understanding the knowledge
and the implications of that knowledge, nurses
are able to MANAGE a wide range of human
health problems

Dashboards
• The presentation of data may also take
the FORM of a dashboard

Data Mining
• Traditional methods of retrieving
information from databases NO
LONGER WORK with the sheer amount
of data that the healthcare industry is
producing.

Predictive Analytics
• One of the main outcomes of data
mining is usually predictive analytics.
Predictive analytics allow us to
ANALYZE and MINE the data FROM the Expert Systems
past with the intention of being able to • Expert systems REPRESENT the
predict the future. present and future vanguard of
nursing informatics. These systems
Benchmarking
aim to help make the NURSE “more
• The process of benchmarking is “the
intelligent” in providing quality care
CONTINUOUS PROCESS by which an
based on evidence.
organization can measure and
compare its own processes with those Evidence-Based Practice
of organizations that are leaders in a • The concept of evidence-based practice
particular area” (Benson, 1994, para 1). is widely accepted across each of the
healthcare disciplines; however, the
Decision Analysis and Decision Support
Systems REALITY of providing evidence-based
• PACKAGING of data into decision care at the point of care is often an
analysis and decision support systems is elusive goal. With the advent of Big
a CRITICAL STEP in healthcare. The Data and data analytics techniques
purpose of this system is NOT TO capable of analyzing Big Data along with
REPLACE the decision-making ability expert systems capable of analyzing
of the healthcare professional, but unstructured data and using natural
rather to supplement it by showing language to present the resulting

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conclusions, real-time evidence-based

practice is a potential reality

Value-Based Patient Centric Care

• Value-based healthcare is a DELIVERY
MODEL where the focus is on
outcomes. This means that healthcare
providers receive payment based on
outcomes, NOT FEE for services.
• The idea is that patients would pay less
for achieving better health, patient
satisfaction would GO UP, costs would
be reduced for payers, and society
becomes HEALTHIER (NEJM Catalyst,
2017)