Chapter – 1

Introduction to Computer
Applications
Arashgeet Kaur
Learning Objectives
• Identify and define various concepts used in computer
• To understand the characteristics of computer
• To understand the structure of computer and its various components
• Identify application of computer in nursing
Chapter Outline
• Introduction to computer and its characteristics
• Applications of Computers
• Structure of Computers
• Uses of Computers in Teaching, Learning, Research and Nursing Practice
Introduction to a Computer
• A programmable, electronic device that can store, retrieve and process data
• Operates under the control of instructions stored in its own memory
• Basic computer functions:
• Accepts data (input)
• Processes input according to the specified rules/ instructions
• Produce result (output)
• Stores output for future use

Input Processing Output

Storage
Characteristics of Computers
• Speed: Ability to execute million instructions per second
• Diligence: Run tirelessly and with consistency
• Accuracy: Minimal chances of error while working on data, subject to right data
and instructions being input into the system
• Storage Capability: Huge amounts of data can be stored and retrieved as
required by the user
• Versatility: Perform several tasks for personal or business purposes
• No feelings: Instructions-based decisions
Applications of Computers
• Banking: Online accounting, checking charges, records, withdrawing money via
ATMs, etc.
• Insurance: Maintaining and updating client database and insurance policy details
• Marketing: Creating and printing advertisements, Designing product catalogues,
etc.
• Business: Planning & budgeting, performance analysis, maintaining employee
database, etc.
• Education: Online certificate courses, hybrid learning environment.
• Communication: Emails, Video-conferencing, IM, etc.
• Healthcare: Diagnostic and monitoring systems, Record keeping, Inventory
management, etc.
• Entertainment: Playing videos, games, etc.
Importance of Computers in Hospital
Maintaining patient history
Helps in diagnoses & treat timely
accurately

Easy and secure access to

Efficient record keeping
required medical data

Functioning of several Medical imaging during surgical

machines (X-Ray, MRI) procedures

Effective inventory Adequate stock for patients’

management needs
Structure of computer
 Structure of Computer
• Multiple devices operate together in an integrated ecosystem.

Computer

Hardware Software

Input Output System Application

Devices Processing Memory Devices Software Software

Control Primary Secondary

ALU Unit Storage Storage
Hardware & Software
Hardware Software
Physical elements of the computer Encoded information (programs and data) used
by computer to process data as per instructions
Can be touched and seen Cannot be touched
Divided into four categories: Divided into two main categories:
- Input devices - Application Software
- Output devices - System Software
- Processing devices
- Storage devices
Developed using electronic components and Developed by writing instructions using a
other materials programming language
Can be replaced if damaged Can be re-installed if damaged
e.g. CPU, Scanner, Printer, etc. e.g. Google Chrome, Microsoft Word, etc.
Input Devices
• Devices used to enter information and instructions into the computer for storing/
processing
Mouse: Pointing device used to control
OMR: Captures data from OMR sheets
the cursor movement on the screen

Keyboard: Has alphabets, numbers and MICR: Magnetic Ink Character

special character keys Recognition, generally used by banks

Touchpad: Alternative to mouse, that Bar Code Reader: Reads bar code data,
senses the finger motion decodes it and sends to the computer

Touch Screen: Selection by touching Microphone: Takes sound as an input

the display screen while recording music or videos

Light Pen: Allows to input with more Webcam: Small cameras used to record
accuracy videos

Scanner: Scans images, text and Digital Camera: Device used to capture
objects to convert into digital image images and videos
Processing Devices
• CPU (Central Processing Unit):
• Processes input
• Takes instructions from memory
• Makes required calculation based on the instructions and type of data
• Produces result

ALU (Arithmetic Logic Unit)

Performs arithmetic functions and
logical operations
CPU
(Brain of the Computer)
Control Unit
Determines sequence of execution
of instructions during processing
 Memory
Memory • Storage: Process of saving data and
instructions
Primary Secondary Primary Storage Secondary Storage
Memory Memory Also called ‘internal memory’ or Also called ‘back-up
‘main memory’ memory’
Hard Disk It holds program instructions, It is permanent storage (Non-
RAM ROM Drive input data & intermediate results volatile memory)
while processing

Solid State Located on computer External to computer

DRAM PROM Drive motherboard, close to CPU
Faster access time Slower access time
Optical Less storage capacity Can store large amounts of
SRAM EPROM Drives data
High cost Lower cost
Consists of RAM and ROM Includes HDD, SSD, Optical
EEPROM
drives, and Tape Drives
Primary Memory
RAM (Random Access Memory) ROM (Read Only Memory)
• Read and write memory • Read memory
• Volatile memory • Non-volatile, hence used for crucial
• Very fast information
• Types of RAM: • Used for start-up process of computer
• DRAM – Dynamic RAM • Types of ROM:
• SRAM – Static RAM. Faster, bulkier and • PROM – Programmable ROM
more expensive than DRAM. • EPROM – Erasable Programmable ROM
• EEPROM - Electrically Erasable
Programmable ROM
 Secondary Memory
HDD (Hard Disk) SSD (Solid State Drive) Optical Drives
• Electro-mechanical, non- • Non-volatile • Read and write of
volatile disk • Can be written and information uses light
• Magnetic device overwritten • Cheap, light-weight and
• Used to store OS, installed • No moving parts easily transportable
software and user’s data • Faster because data is • Types of Optical Drives:
• Cheaper and durable stored electronically • CD Drive
• DVD Drive
• HD DVD
Output Devices
• Used to display results after input data has been processed
• Provide data output as desired and understood by user

Monitor: Interface between

user and CPU. It displays Sound Car & Speakers:
the graphical information. Product audio

Printer: Prints digital

information on to paper. Screen Projector: Projects
Different types: Laser, images or videos on to a
Inkjet, Dot Matrix Printer bigger screen
System Software
• Controls working of the computer system
• First loaded into memory when a computer is turned on
• Runs only in background of the device, hence called ‘Low-Level Software’
• Types of System Software:
• Operating System (OS): Allows applications and devices to be identified and function. For
e.g., Microsoft Windows, Mac, Linux, iOS, Android
• Device Drivers: Used to connect computer components to perform their intended tasks
• Firmware: Operational software for the OS to control and manage activities of hardware
• Utilities: For diagnostic and maintenance tasks
Application Software
• Set of programs to carry out a specific application
• Types of Application Software:
• Word Processing Software: To type and modify documents for creating letters, reports etc.
For e.g., Microsoft Word, Notepad, WordPad, etc.
• Spread Sheet Software: To tabulate data and make computations. For e.g., Microsoft Excel,
Apple Numbers, etc.
• Database Software: To store and sort information in a database. For e.g., Microsoft Access,
MySQL
• Presentation Software: To create presentation slides’ deck. For e.g., Microsoft PowerPoint
• Multimedia Software: To create, edit or view media content. For e.g., Winamp, VLC, etc.
• Graphics Software: To edit changes in visual data. For e.g., Adobe Photoshop
• Internet Browsers: To browse internet for educational, entertainment or other purposes. For
e.g., Google Chrome, Internet Explorer, etc.
Uses of computer
Computers help nurses beyond electronic record-keeping and in providing quality
health care to patients
Research
• Computers are useful tool for conducting medical research work
• Nurses can update themselves by surfing online databases, websites and
applications for relevant information
• Nurses have access to verified online libraries, medical journals and other
available resources
• Competitive edge for nurses for professional growth
Nursing Practice
• Diagnosis
• Digital records can be used anywhere and anytime for diagnosis.
• Easy access to manuals for medical devices to be used.
• Electronic records are convenient to record, handle and transfer.
• EHR gives easy access to nurses for patient’s medical history.
• Computers reduce diagnosis time and errors as the nurses can refer to online resources and medical
references online.
• Telemedicine
• Convenient to establish communication with patients where physical appointments can’t be scheduled.
• Easy to secure expert opinion in hospitals located in rural areas or where there is shortage of medical
staff.
• Increased collaboration among medical professionals around the globe via chatting apps to get advice on
medical concerns.
• Inventory Management
• Accurate stocks and shelving information maintained by nurses for medicines.
• Efficient purchase and handling by analysing stock movement and forecasting the future requirement.
Teaching / Learning
• Computer Aided Teaching & Testing
• Use of technology for the formation, exploration, modification and enrichment of teaching.
• Computer – assisted Translation
• Improved self-learning for students by facilitating translation of content
• Increased effectiveness and information retention among the students.
• Teaching through Presentations
• Easy to integrate PPT with conventional classroom learning.
• Can be used to introduce topics and go through complex topics one-by-one, and referred by students as per their need.
• Effective method for teachers to engage and hold students’ attention.
• Used by students to present their projects’ findings and results.
• Online/e-Learning
• Concurrent learning: Engaging students via teleconferencing app and interacting with them in instructor-led classes
and virtual classroom discussion panels
• Non-concurrent learning: Use of online course material for students to learn & take assessment at their own pace.
 Computer Aided Teaching & Teaching
Computer Aided Teaching Computer Assisted (or Aided) Testing
• Uses technology for the formation, exploration, • Using computers to test and evaluate students’ learning
modification and enrichment of teaching.
with the help of computers.
• Increases productivity, develop better understanding &
learning for the students. • Students’ responses are evaluated using an application.

• Features of Computer Aided Teaching: • Generates statistics report (e.g., class performance, most
• Engaging and effective classes for students & better incorrectly answered question, etc.)
learning experience • Features of Computer Aided Testing are:
• Better understanding of fundamental concepts displayed via
graphics • Increase in accuracy.

• Several modes of Computer Aided Teaching: • Decrease in chances of bias.

• Tutorial Mode – Uses course materials for information • Lesser evaluation time as compared to manual checking.
• Drill & Practice Session – Uses questions and analysis of • Reduction in paperwork.
the responses
• Easy retrieval of questions and student’s performance.
• Simulation – Uses computerised imitation of a real-life
process
• Modelling – Creating theoretical models.
• Data Analysis – Working and analysing experimental data
Computer Aided Teaching & Testing
Benefits Challenges
• Visual Learning – Enhanced learning experience • Cost – Involves cost to develop effective online
by using media, helping students retain longer. courses & applications, set up computer system and
• Measures Progress – Students can choose online working internet connection for online courses and
courses of their own interest, and keep progressing research.
with content & evaluation at their own pace.
• Difficult implementation – CAT requires
• Simple Structure – Small modules of big concepts infrastructure & funds, and instructor to
are simple for students to understand and learn. technologically upgrade.
• Engaging – Increased effectiveness of teaching • Isolation among students – Students may feel
methodologies by increasing student engagement.
isolated due to lack of physical student-teacher
• Communicating with international colleagues – interaction, or language barrier.
Allows easy collaboration with Subject Matter
Experts virtually from all over the world. • Mismatch with the teaching objectives –
Misalignment between prepared course material
• Time Saving – Quick and accurate evaluation of and teacher’s objectives for a particular class.
students’ responses as compared to manual
evaluation.
• Unbiased – Evaluation of tests based on a criterion
giving unbiased results.
Summary
• Computer is a programmable, electronic device that can store, retrieve and process
data.
• Characteristics of computers include speed, diligence, accuracy, storage capability,
multi-tasking and versatility.
• Computers are used across all industries, including banking, entertainment,
nursing, engineering, research, etc.
• Computers consist of hardware and software.
• Computers are used for Computer Aided Teaching and Testing to engage students
effectively using media and presentations.
 Chapter – 2

Introduction to Operating Systems

and Windows
Arashgeet Kaur
Learning Objectives
• Develop a basic understanding about Operating System
• Describe and use Disk Operating System
• Introduction to Windows and its Features
• Develop a basic understanding of Operating Systems other than DOS and Windows
Chapter Outline
• History of Operating System
• Basic Features of DOS
• Introduction of Windows
• History of Windows
• Difference between Windows and DOS
• Features in Windows
• Advantage of Windows 10 over previous versions
• Other Operating Systems (Unix, Xenix, Linux)
Introduction to Operating Systems
• Operating System is example of System Software.
• Manages software files, hardware files and helps to access them.
• Performs basic tasks for computer programs: File management, memory
management, handling input and output, & controlling hardware.
• Acts as interface between the user and hardware.
• History of OS:
• 1956: First OS, called GMOS, developed by General Motors to run a single IBM Computer.
• 1975: First Window OS created by Microsoft.
• 1981: MS-DOS introduced by Bill Gates and Paul Allen.
• 1980s: Mac OS developed by Steve Jobs for Apple devices.
DOS – Introduction & Structure
• DOS (Disk Operating System) – First OS used by IBM-compatible computer.
• Structure of DOS:
• Layered structure, with each layer having a different functionality
• Easier to create, maintain and update system
• BIOS (Basic Input/ Output System): Provides instructions for booting the computer. Also
provides drivers for basic hardware like keyboard and mouse.
• Kernel: Set of programs and codes to provide services to the user, such as: File Management,
Memories Management, Real-time Clock Access, Device Driver Binding services, etc.
• Shell: Facilitates interaction between hardware & software, by delivering a fixed set of
commands that gives user the access to manage files, the device, its configuration, etc.
MS-DOS Commands
• DOS is single-tasking, single-user OS with command-line interface.
• Commands: Certain English words, recognized by DOS, and it acts accordingly.
Internal Commands
Constructed as a portion of a file named [Link].
Loaded into the memory when computer is turned on.
Examples: DIR, DATE, TYPE

External Commands
Commands Commands that have an extension namely COM or EXE.
Not stored into the operating system.
Examples: EDIT, FIND

Wild Cards
Symbols (*, ?) used to display a listing of subsets of files and subdirectories.
Introduction to Windows
• Most common Operating System nowadays
• Developed by Microsoft Corporation
• Launched in November 1985
• Basic features of Windows:
• GUI (Graphical User Interface) operating system
• User-friendly
• Allows multiple users
• Allows multi-tasking
• Capable of connecting computers to a global network
• Can run Multimedia
• Users can command the computer by clicking icons, menu and other buttons with
the help of mouse or by using keyboard.
History of Windows
• Windows 1.0 – November 1985 • Windows NT Workstation 4.0 – August 1996
• Windows 2.0 – December 1987 • Windows 98 – June 1998
• Windows 3.0 – May 1990 (This was the first • Windows ME – September 2000
successful windows OS) • Windows 2000 Professional – February 2000
• Windows 3.1 – April 1992 • Windows XP – October 2001
• Windows NT 3.1 – July 1993 • Windows Vista – November 2006
• Windows for Workgroups 3.11 – August 1993 • Windows 7 – October 2009

• Windows NT Workstation 3.5 – September • Windows 8.0 – October 2012

1994 • Windows 8.1 – October 2013
• Windows NT Workstation 3.51 – May 1995 • Windows 10 – July 2015
• Windows 95 – August 1995 • Windows 11 – June 2021 (Released preview)
Differences – Windows & DOS
Feature Windows DOS
Has Graphical User Interface, and instructions are Command line based OS, where instructions
Type
provided through icons and menus are given via commands
Launched in 1985 and holds market dominance Launched in 1981 and was popular till 1995 in
Launch
today IBM computers
Multi-
Multi-tasking and multi-user OS Single-tasking and single-user OS
tasking
Memory Consumes more memory and power Consumes less memory and power
Supports multimedia such as songs, movies and
Multimedia Multimedia is not supported
games, etc.
Supports networking, and allows connection to Does not support networking and hence
Connectivity
devices such as printers, shared memory, etc. difficult to share files
Complex and difficult to use as user needs to
Easy to use as no commands need to be
Ease of Use remember various commands to perform the
memorized
actions
Price Paid software and requires license for activation Free and does not need licensing
Advantages of Windows 10
• Universal application, i.e. it can run in all desktop computers, laptops, and tablets.
• Faster response to user commands.
• Reintroduction to traditional ‘Start Menu’, which shows applications
alphabetically as well as has options to pin frequently used applications.
• Presence of faster web browser to surf the internet.
• Presence of virtual assistance ‘Cortana’.
• Virtual desktop feature.
• Presence of both Tablet mode and Desktop mode.
• Better gaming experience.
Features of Windows OS
• Desktop: Background screen which contains several elements like Icons, Start
Menu button, Taskbar, Notification panel, etc.
• Icons: Small picture buttons that are present on the desktop screen, for e.g. My
Computer, Recycle Bin, Microsoft Edge, etc.
• Taskbar: Desktop toolbar that helps to perform tasks such as searching and
starting a new application. It holds the Start/ Windows Button, Icons for active
applications, clock and other options (Volume, Internet connection & Battery), etc.
• Desktop Background: It can be changed to a solid color, in-built wallpapers or
any image saved in the computer.
• Start Menu: Accessed from Windows button, it is used to access different
applications in the computer.
Features of Windows OS… Contd.
• Control Panel: Displays a list of tools to configure and adjust computer’s settings,
related to: System and Security, User Accounts, Network & Internet, Appearance,
Hardware, Ease of Access, etc.
• Cortana: Window’s virtual assistant accepts voice commands and can perform
actions such as answering questions, searching computer or internet, setting
reminders and performing online purchases, etc.
• File Explorer: Provides the view of files and folders, and is used to browse
through the contents as well as rename/ move/ copy them on the computer.
• Internet Browser: Used to run searches in computer connected to a working
internet connection by typing in the query. Also used to make online purchases,
access maps, download multimedia, etc.
Features of Windows OS… Contd.
• Calculator: Used to make calculations, along with Scientific, Graphic,
Programmer, and Conversion options among others.
• Camera: Used to take photos or videos.
• Paint: Used to create and edit drawings and images.
• Notepad: Simple text editor used to create, view and edit text files.
• Run: Used to open any program, document or folder.
• Snipping Tool: Used to snip a part of the screen that can be saved, edited or used
for illustration in a document.
• Sticky notes: Small notes that appear on desktop screen to write small notes.
• Voice Recorder: Used to record voice in a computer via inbuilt or connected mic.
• Word Pad: Advanced version of Notepad with additional formatting features.
Renaming a Folder/ File
• Select the file by right clicking on it.
• A dropdown menu appears.
• Select the option to rename.
• The file name now becomes editable.
• Rename the file now by typing in the new file name.
• Press ‘Enter’ key or click anywhere else on the window after renaming the file.
• The file’s name is now changed.
Copying a Folder/ File
Using Options from Dropdown Menu Using Keyboard Shortcuts
• Select the file by right clicking it. • Select the folder. Use keyboard
• A dropdown menu appears. shortcut keys ‘Ctrl + C’ to copy the
file.
• Select ‘Copy’ from the menu. Your file
will be copied. • Your file will be copied.

• Go to the destination folder where the • Go to the destination folder where

file is to be duplicated. the file is to be duplicated.

• Right click in the Destination Folder • Paste the file by using the shortcut
window, and click on ‘Paste’. keys ‘Ctrl + V’.

• Your file will successfully paste. • Your file will successfully paste.
Moving a Folder/ File
Using Options from Dropdown Menu Using Keyboard Shortcuts
• Select the file by right clicking it. • Select the folder. Use keyboard
• A dropdown menu appears. shortcut keys ‘Ctrl + X’ to cut the
file.
• Select ‘Cut’ from the menu.
• Go to the destination folder where
• Go to the destination folder where the the file is to be moved.
file is to be moved.
• Paste the file by using the shortcut
• Right click in the Destination Folder keys ‘Ctrl + V’.
window, and click on ‘Paste’.
• Your file will successfully be
• Your file will successfully be moved moved.
to the desired location.
Deleting a Folder/ File
Using Options from Using Keyboard Permanently Deleting
Dropdown Menu • Select the folder/ file by • Select the folder/ file by
• Select the folder/ file by clicking on it. clicking on it.
clicking on it. • Click on ‘Delete’ key • Click the shortcut keys
• Right click to open a from keyboard. ‘Shift + Delete’.
dropdown menu. • The file moves to the • This permanently
• Click on ‘Delete’. Recycle Bin. deletes the file.
• The file moves to the • From there, you can
Recycle Bin. either permanently
• From there, you can delete or restore your
either permanently file.
delete or restore your
file.
 Other Operating Systems
Unix Xenix Linux
• Developed by Ken Thompson, • Licensed from Microsoft and AT • Linux is an OS distributed under
Dennis Ritchie and others at & T Corp. in the late 1970s. an open source-license.
AT&T Laboratories in the 1970s. • Discontinued version of Unix OS • Can be downloaded from the
• Unix is the base of other microcomputer platforms official Linux website.
operating systems such as • SCO later acquired it & replaced • Has similar functionality to Unix.
Ubuntu, Solaris, POSIX, etc. it with SCO UNIX (now known • Kernel is a program at the heart
as SCO Openserver). the of the Linux OS taking care of
• System structure of Unix: Level 1
(Hardware), Level 2 (Kernel), • Mid-to-late 1980s: Xenix was the the fundamental stuff, like letting
most common Unix variant, hardware communicate with other
Level 3 (Shell), and Level 4
measured according to the software system.
(Application Layer)
number of machines on which it
was installed.
Summary
• Operating System is example of System Software, that manages software files,
hardware files and helps user to access them.
• First OS, called GMOS, developed by General Motors.
• DOS (Disk Operating System) – First OS used by IBM-compatible computer, has
a layered structure. It is single-tasking, single-user OS with command-line
interface.
• Windows is the most common OS nowadays, developed by Microsoft Corp., and
launched in Nov 1985.
• Windows has several features: Desktop, Background, Start Menu, Control Panel,
Notepad, Camera, Calculator, etc.
• There are other OS, such as Unix, Xenix, and Linux.
 Chapter – 3

Introduction to
Microsoft Office Access
Arashgeet Kaur
Learning Objectives
• To understand the basic features of Microsoft Access.
• Describe the benefits of Microsoft Access.
Chapter Outline
• Opening MS-Access
• Components of MS-Access
• Creating a new Database in Access
• Creating and Editing Tables in Access
• Forms in MS Access
• Queries in MS Access
• Reports in MS Access
• Saving/ Closing/ Opening/ Printing a Database
Introduction to Microsoft Access
• Database is a collection of organised data such that it can be easily retrieved.
• Database consists of fields, records, and files.
• Field: A single piece of information, e.g. your first name
• Record: A complete set of fields, e.g. your entry in telephone diary
• File: A collection of records, e.g. the entire telephone diary

• Microsoft Access is a Database Management System (DBMS), launched in 1992.

• Easy-to-use tool to create business applications from scratch or pre-defined templates.
• A relational database.
• Can store information for reference, reporting and analysis.
• Helps compare and explore relationship between existing data.
• Can be used to manage bills, create trackers or logs, and make websites.
Benefits of Microsoft Access
• Less expensive as compared to other large database systems, such as Oracle.
• Robust and flexible as it can perform any challenging database tasks.
• Easily integrated with other software in Microsoft Office Suite.
• User-friendly, saves time and reduces error by easily importing several data
formats as to not lose the existing data.
• Convenient for distribution as its Jet Database format contains both application
and data in one file.
Opening MS Access
• Open Start Menu > All Programs > Microsoft Office > Microsoft Access.
• MS Access opens and the page shows several templates, e.g. Nutrition Tracking, etc.
• User can also search for templates online to find a fit-for-purpose template.
• Select a template and enter name for your database.
• Select the location to save it and then click on ‘Create’.
Components of MS Access
• Table: Main feature of MS Access used to save, store and process data. Database might return
wrong results if tables are not set up with correct relationships.
• Queries: Used to process data in the table, in order to extract understandable information, as a
form or report. They can sort, calculate, group, filter, join, update and delete tables.
• Relationships: Bond built between tables, which joins them with associated elements in a
particular field.
• Macros: Used to carry out series of actions for database, such as open forms, run queries, change
field values and run other macros, etc.
• Forms: Used to receive input data from user as a table or query in form of buttons or grids.
• Reports: Result produced after processing data in the database. It is created from a table or other
sources of data using Report Wizard available in Access Toolbar.
• Module: Basis of programming language that supports MS Access. Module window is used to
write and store VBA.
• Database: Two types of Database in MS Access: Flat File Database and Relational Database.
Creating New Database in MS Access
• When you open MS Access, choose ‘Blank Desktop Database’ from templates.
• Alternatively, click on ‘File’ in Menu Bar > ‘New’ > ‘Blank Database’.

• File Name dialog box will appear

• You can rename the file.
• Use icon besides the file name, to select the location for saving the database.
• Enter the file name and click on ‘Create’
Creating Tables in MS Access
• Table is created to store data in a database.
• To create a table:
• Go to ‘Create’ Menu > ‘Table’ in Tables section.
• Default table is created with name ‘Table1’.
• The first column is ‘ID’ and has numbers by default. It is also the unique key of the table.
Editing Tables in MS Access
• Rename table headings in subsequent columns: Double click on column header,
and rename it.
• To add column:
• Select any category, i.e. Short text, Numbers, etc. from ‘Add & Delete’ under ‘Fields’ Menu.
• New column is added with default name as ‘Field1’. To rename, double click on the column
header.

• Saving the Table: Use keyboard shortcut ‘Ctrl + S’.

• Adding data in the table: Start by entering values, one row at a time, similar to a
spreadsheet.
Editing Tables in MS Access… contd.
Deleting a column Deleting a Row
• select the column by moving cursor to the • Click on row beginning.
column header. • Right click to open a menu.
• Cursor will change to an arrow, and • Select ‘Delete Record’
clicking it will select the entire column.
• Click on ‘Delete’ from ‘Add & Delete’
section under ‘Fields’ Menu.
Editing Tables in MS Access… contd.
• To create a table using Table Design, follow the steps as listed below:
• Click on ‘Table Design’ under ‘Create Menu’ > Table Dialog Box appears.
• For each field, enter: Field Name, Data Type and Description (optional).
• To add a field as primary key: Select it and click on ‘Primary Key’ under ‘Tools’ category
under ‘Design’ Menu. It shows a key icon before the field name.
• Save the Table using keyboard shortcut ‘Ctrl + S’.
• To switch between Datasheet view and Design view, Click on ‘View’ under ‘Design’ menu
and select the desired view.
Forms in MS Access
• Form: Database object used to create a user interface a database application.
• Used to easily view, enter and change data one row at a time.
• Contains a button used to print a report, open other objects as well as automate
tasks.
• A form can be created using four ways:
• Form
• Form Wizard
• Multiple Item
• Split Form
Creating a Form in MS Access
• Click on ‘Create’ > Select ‘Form’ under Forms category.
• Table is now displayed as a form.

• All columns of Table appear by default (i.e., ID, RollNo, Name of the Student)
with values of first row by default.
• You can change the data, add or delete and then save it to create a new form.
Queries in MS Access
• A query is used to:
• Find and retrieve data meeting specified conditions.
• Update or delete multiple records simultaneously.
• Perform calculations on your data.
• Queries are very versatile and can be created based on the type of task.
• There are two major query types:
• Select: This query type is used to retrieve data from the table as well as make calculations.
• Action: This query type is used to add, modify or delete data.
Reports in MS Access
• A report is used to quickly analyse data or present it in a desired way.
• Report can be used to create mailing labels, shows totals in chart or display calculated
totals.
• To create a report, follow the steps listed below.
• Click on ‘Create’ menu > ‘Report Wizard’. Report Wizard dialog
box opens.
• Select Table or Query for which report is to be generated. It then
shows the list of ‘Available Fields’ in the Table.
• Choose which fields to display in the report. After choosing the
fields, click on ‘Next >’.
• The next window is used to select the order in which the report is
required. Click on ‘Next >’.
• The next window is used to select layout and orientation, Click on
‘Next >’.
• The next dialog box lets the user rename the report. Click on
‘Finish’.
• The report is now ready.
Saving a Database
• A database needs to be saved after working on the required data records so that it
can be accessed later.
• Steps to save a database:
• Click on ‘File’ in the Menu Bar.
• Click on ‘Save’.
• Select what is to be saved (i.e. Table, Report, Form, etc.) depending upon the version of the
software.
• After you choose the desired location, click on ‘Save’.
• The database is stored in “.accdb” format.
• Steps to save the database in a different location, or in a different format:
• Click on ‘File’ in the Menu Bar and select ‘Save As’.
• You will see two options: ‘Save Database As’ and ‘Save Object As’.
• Under ‘Save Database As’, different formats can be chosen.
• Select the desired format and click on ‘Save As’.
• Choose location, rename the file and then click on ‘Save’.
Saving a Database… contd.
• Different database formats available
are:
• Access Database (.accdb): Default
database format.
• Access 2002-2003 Database (.mdb):
Compatible with Access 2002-2003.
• Access 2000 Database (.mdb):
Compatible with Access 2000.
• Template (.accdt): Used to save the
current database as database template.
Closing a Database
Steps to close a database that you are currently working on:
• Click on ‘File’ from the Menu Bar.
• Select ‘Close’.
• A dialog box appears for user to either save or cancel any changes that have not
been saved yet.
• After making the desired selection, MS Access closes.

Alternatively: Click on Close Button at the top right corner of MS Access. Again a
dialog box appears to either save or cancel any changes.
Opening a Database
Steps to open a database that had been previously saved and closed:
• Click on ‘File’ from the Menu Bar.
• Select ‘Open’.
• A dialog box opens for user to navigate to the desired location where the file is
stored.
• Double click on the file to be opened.
• MS Access will open the desired file.
Printing a Database
Steps to print the database:
• Click on ‘File’ Menu in the Menu Bar.
• Click on ‘Print’.
• You can change the layout for print (such as page size, margins, etc.)
• Select the printer and then click on ‘Print’.
Summary
• Microsoft Access is a Database Management System (DBMS), launched in 1992.
It is an easy-to-use tool to store information for reference, reporting and analysis.
• A table is created to store data in a database.
• A form is a database object used to create a user interface a database application,
and is used to easily view, enter and change data one row at a time.
• Queries are very versatile and can be created based on the type of task, such as
make calculations or to add and modify data.
• A report is used to quickly analyse data or present it in a desired way.
• A database can be stored after completing the work in different formats as per
requirement.
 Chapter – 4

Introduction to
Microsoft Word
Arashgeet Kaur
Learning Objectives
• To understand basic features of Microsoft Word
• Creating a new document
• Editing and enhancing an existing document
• To develop skill to use MS Word
• To show proficiency using MS Word
Chapter Outline
• Introduction to MS Word
• Opening MS Word
• Features of MS Word: Home Tab, File Tab, Insert Tab, Design Tab, etc.
• Creating a New Document
• Saving a Document
• Closing a Document
• Opening a Document
• Printing a Document
Introduction to Microsoft Word
• Microsoft Word is a word processor developed by Microsoft, and first launched in 1983.
• MS Word is used for writing letters, student assignments, business reports, making resumes, and
creating newsletters.
• Several versions of MS Word have been released: Word 2007, Word 2010, Word 2013, Word 2016,
and Word for Office 365 being the latest.
• MS Word is available on Windows based laptops, Apple laptops and phone devices as well.
• MS Word can be used to handle and create reports that help generate benefits in healthcare
industry:
• Superior document quality
• Reduced paperwork
• Higher efficiency and productivity.
Opening MS Word
• Open Start Menu > All Programs > Microsoft Office > Microsoft Word.
• When MS Word opens, the page shows several templates (e.g. Report, Blog Post, Resume, etc.).
• The user can also search for templates online to find a fit-for-purpose template.
• To create a document from scratch, click on ‘Blank Document’.
Basic Layout of MS Word
Features of MS Word
• Quick Access Toolbar: Customizable toolbar located on top left and displays buttons to perform
quickly used commands (Save, Undo & Redo).
• Title Bar: Displays the name of the document.
• MS Word Help: Help button located on top right that opens a list of help topics.
• Window Controls: Close, Restore Down, Minimize buttons located on top right corner.
• Ruler: Used to change the indent of a line or document using Left/ Right Indent.
• Work area: White sheet below the ruler where contents or images are inserted in the document.
• Insertion Point: Blinking vertical line in the work area that indicates where text or graphics will
be inserted.
• Scroll Bar: Two scroll bars (vertical and horizontal) allow users to move the document up and
down or right and left.
• Status Bar: It is located at the bottom of the document and displays page number, layout options,
proofing views and word count.
Features of MS Word
• Ribbon: Introduced in MS Word 2007, it contains the Menu Bar with various
tabs:
• File Tab: Deals with file management tasks such as creating or opening, saving, printing,
sharing or publishing a file.
• Home Tab: Contains sections for formatting the data.
• Insert Tab: Used to add elements to the document other than text, such as images, graphs,
symbols, page numbers, etc.
• Design Tab: Deals with formatting the design of the document.
• Page Layout Tab: Deals with the setting of page.
• References Tab: Used to add Table of Contents, Footnotes, Citations, etc.
• Mailings Tab: Used to create envelopes, start Mail Merge, etc.
• Review Tab: Deals with proofing the document and tracking changes when document is
edited by multiple authors.
• View Tab: Deals with the look of the document.
File Tab
• Info – Displays properties of the document such as size, number of pages, word
count, title, author, creation and modification date, and options for protecting &
inspecting the document.
• New – Used to create a new document either from scratch or choosing a template.
• Open – Used to open a document saved previously on the computer.
• Save – Used to save the current file in the computer or online in OneDrive.
• Save As – Used to save the file with the same or different name in different location
or in a different format (e.g. pdf, .txt, etc.)
• Print – Used to print the document, and shows options for choosing a printer and
other settings (Number of copies, orientation, etc.)
• Share – Used to share the file online via email, or inviting people to collaborate.
• Export – Used to change the file format.
• Close – Used to close the document.
• Account – Displays the user and product information.
• Options – Used to change the general settings of MS Word.
Home Tab

• Clipboard: Has options for cut, copy, and pasting the text.
• Format Painter: It ‘paints the format’ of the selected text to the desired text such that they look
alike.
• Font: Used to format the text, i.e. change its appearance by using features such as making the text
bold, italicizing, changing its font, font size, colour and style, etc.
• Paragraph: Used to add bullets and change alignment.
• Styles: Contains multiple style options to change the style of the text heading and body.
• Editing: Used to find, select or replace a specific word or phrase.
Insert Tab

• Pages: Used to add a cover page, blank page or page break at the insertion point.
• Tables: Used to add table, with desired number of rows and columns, and change its design and
layout.
• Illustrations: Used to insert and edit pictures, shapes, SmartArt, and charts.
• Apps: Allows to add an app from the ‘Office Store’.
• Media: Used to add Online Video or other online sources into the document.
• Links: Used to add a hyperlink, bookmark and cross-reference.
• Comments: Used to add notes in the document while reviewing it.
• Header & Footer: Used to repeat same content at either top or bottom of every page.
• Text: Used to add text box, WordArt, date and time, and object into the document.
• Symbols: Used to insert a mathematical equation and symbols in the document.
Design Tab

• Document Formatting: Has options to change the theme, and colours, fonts and paragraph
spacing of the theme used in the document.
• Theme: Represents a set of colours, fonts and effects to create a consistent look and feel in the
document.
• Page Background: Has options to add Watermark to the document, change page colour or add
border to the pages.
• Watermark: Generally light-coloured text behind the content of the document, used to write an
important message, such as ‘Confidential’ or ‘Urgent’.
Page Layout Tab

• Page Setup: Has options to set page margins, change page orientation and size, split text into
columns, add breaks, and create hyphenation in the document.
• Paragraph: Used to change indent (i.e. space between margin and text boundary) and spacing
between paragraphs.
• Arrange: Used to change the position of image/ object and wrap text around it. Also has options to
align, group and rotate images or objects added in the document.
References Tab

• Table of Contents: Used to add table of contents to give document’s preview, and can be
populated automatically from the headings in the document content.
• Footnotes: Used to add a note at the bottom of the page using footnotes, or at the end of the
document using Endnotes.
• Citations & Bibliography: Used to credit the source of information in the document. It can be
used to site source material and view, organize and style the citations.
• Captions: Used to add label to the images and insert table of figures from the captions along with
page numbers.
• Index: Used to add selected text to index, and add or update index listing word and pages.
• Table of Authorities: Used to add or update the Table of Authorities with cases, statues and other
authorities cited in the document.
Mailings Tab

• Create: Used to create and print envelopes, and add labels while sending emails.
• Start Mail Merge: Used for bulk emails, letters, labels and envelopes.
• Write & Insert Fields: Has features to add address or greeting line to letters, add fields from
recipient list to document, specify rules for mail merge, etc.
• Preview Results: Used to plug in information from the recipient list into merge fields to see the
final document.
• Finish: Used to complete the mail merge.
Review Tab

• Proofing: Used to check the entire content of the document for misspells and grammatical errors,
check meaning of a word, or count the number of words in the document.
• Language: Used to translate text into another language and selecting language for proof reading
the document.
• Comments: Used to insert/ delete/ navigate comments.
• Tracking: Used to track the changes made to the document when multiple people are working on
revising it.
• Changes: Used to accept/ reject/ navigate changes done in a document.
• Compare: Used to compare or combine multiple versions of the same document.
• Protect: Used to block authors or restrict editing by others.
View Tab

• Views: Used to see document in different views (Read mode, Print Layout, Web Layout, Outline,
and Draft).
• Show: Used to choose whether to see ruler, gridlines and navigation pane in the document window.
• Zoom: Used to choose the level of viewing as per requirement and comfort.
• Window: Used to open current document in multiple windows and arrange them for easy viewing.
Also has options for viewing those document side by side, synchronous scrolling through them,
etc.
• Macros: Used to access or record a Macro, i.e. an instruction that gives a specific output for a
particular input.
Creating a New Document
• Steps to create a new document:
• Click on ‘File’ Menu.
• Select ‘New’.
• A list of themes open, similar to
when MS Word opens.
• To create a document from scratch,
click on ‘Blank Document’
• This opens a new Word document.
• Alternatively, you can use Ctrl + N
to open a new document.
Saving a Document
• Steps to save document in computer:
• Click on ‘File’ Menu > ‘Save’. Alternatively, click on
Save Icon in the Quick Access Toolbar, or use shortcut
keys: Ctrl + S.
• Choose ‘Computer’ > ‘Browse’ to select a location on
the system.
• ‘Save as’ dialog box opens. Navigate to the desired
location to save the file.
• Type the name in ‘File Name’ field and click on ‘Save’.
• ‘Save As’ is another option used to save a file in a
different location or format:
• Click on ‘File’ Menu > ‘Save As’.
• ‘Save As’ dialog box opens. Select the desired location
to save the file.
• Select the desired format (PDF, Plain text, etc.) using
‘Save as type’ option below the ‘File Name’ option.
Closing a Document
• Safe to close a document after creating a new document and saving it.
• To close a document:
• Go to ‘File’ Menu > ‘Close, or click on ‘Close’ button in Windows Control on top right.
• In case the document has any unsaved changes, Word prompts to save those before closing and
exiting the document.

• Click on ‘Save’ to save the changes made in the document.

• To exit without saving the changes, select ‘Don’t Save’.
• To review the changes made and not exit the document, click on ‘Cancel’. User is then taken
back to the document.
Opening a Document
• Go to ‘File’ Menu > ‘Open’.
• This options shows a list of recently opened documents, or browse through the system folders. Click
on ‘Computer’ > ‘Browse’.
• Select the required Word file and click on Open, or double click on the file to open it.
Printing a Document
Steps to print a Word document:
• Go to ‘File’ menu > ‘Print’. Alternatively, you
can use keyboard shortcut Ctrl + P.
• Printer settings page opens, where settings can
be changed for:
• Pages to be printed
• Print on one or both sides of the page.
• Collated pages or uncollated in case of multiple
copies.
• Orientation (landscape or portrait)
• Margins
• User can see how the document will look like on
the right side of the settings.
• Specify the number of copies required and click
on ‘Print’ command at the top.
Summary
• MS Word is a Word Processor application used for writing letters, student assignments, business
reports, making resumes, and creating newsletters.
• MS Word can be used to handle and create reports that help generate benefits in healthcare
industry, such as superior document quality, reduced paperwork, and higher efficiency and
productivity.
• User can create new documents, edit documents, save and close them, and take prints.
• MS Word has several features to create and edit content that can be accessed from Ribbon
containing several tabs related to formatting, inserting, reviewing, etc.
 Chapter – 5

Introduction to
Microsoft Excel
Arashgeet Kaur
Learning Objectives
• To understand basic features of Microsoft Excel.
• To create a new Sheet.
• To use Excel to make workbook and maintain data.
• To analyse data using Excel.
Chapter Outline
• Introduction to MS Excel
• Basic Layout & Features of MS Excel
• Creating an Excel Workbook
• Inserting/ Deleting Sheets in a Workbook
• Entering/ Editing/ Formatting Data in a Worksheet
• Adding/ Deleting Rows & Columns
• Moving/ Copying Cell Contents
• Overview of Formulae in Excel
• Inserting Illustration/ Charts in Excel
• Creating a Pivot Table to analyse data
• Saving/ Closing/ Opening/ Printing a Workbook
Introduction to Microsoft Excel
• Microsoft Excel is a spreadsheet program used to record, maintain and analyse data.
• MS Excel helps in calculation (e.g., addition, average, standard deviation, trigonometric functions),
graphing (charts, graphs, and reports), pivot tables (summarizing data), etc.
• MS Excel can be used to input data, storing it, arranging and editing data as well as analysing it
and presenting the results.
• The benefits of using MS Excel are listed below:
• Easy to store data and filter required information.
• Easy to recover and retrieve data.
• Convenient to do calculations for multiple data sets using mathematical formulae.
• Data can be saved securely using password protected sheets or workbook.
• Convenient to share data and analysis for other people’s reference and collaboration.
Basic Layout of MS Excel
Features of MS Excel
• Row: Rows run horizontally and are represented by numbers (1, 2, 3 …).
• Column: Columns run vertically and are represented by alphabets (A, B, C…).
• Sheet: All the rows and columns make a sheet.
• Worksheet: The sheet in which the user is currently working.
• Workbook: Multiple sheets makes an Excel Workbook.
• Cell: Intersection of row and column.
• Cell Address: Representation of a cell by row and column number.
• Active Cell: Selected cell, identified by a dark boundary around it.
Creating a New Workbook
• Open Start Menu > All Programs >
Microsoft Office > Microsoft Excel.
• When MS Excel opens, the page shows
several templates (e.g. Report, Blog Post,
Resume, etc.).
• Select ‘Blank Workbook’ to start from
scratch.
• Steps to create a new document if user is
already in Excel:
• Click on ‘File’ Menu > ‘New’.
• A list of templates opens.
• Click on ‘Blank Document’
• This opens a new Workbook.
• Alternatively, you can use Ctrl + N to open a
new workbook.
Inserting/ Deleting sheets in Workbook
• To insert a new sheet:
• Click on + button at the bottom next to sheet tabs, OR Under ‘Home’ menu > ‘Insert’ > ‘Insert Sheet’.
• To rename a sheet:
• Double click on the sheet name and it becomes editable.
• Right click on the sheet name, and a menu appears. Select rename and then give desired name.
• To delete a sheet:
• Right click on the Sheet Tab at the bottom, and click on Delete, OR Under the ‘File’ Menu > ‘Delete’ >
‘Delete Sheet’. A deleted sheet can’t be retrieved.
Rearranging/ Copying sheets in Workbook
• To rearrange/ move sheets:
• Select the Worksheet Tab, and drag and drop it to the required location.
• Right click on Sheet Tab that is to be moved. Select ‘Move or Copy’ and a dialog box opens.
• Select the sheet before which you want this sheet.
• To copy a sheet:
• In the ‘Move or Copy’ dialog box, check the box ‘Create a Copy’.
• Under ‘Before Sheet’, select where you want to copy the sheet.
Entering & Editing Data in a Worksheet
• To add data into a cell: Click on it and start entering the information (alphabets, numbers, decimals,
dates, etc.)
• User can use arrow keys to move to another cell or by clicking on it.
• Data being typed in to the active cell is also visible in the formula bar.
• Auto Fill: Certain series (such as numbers, dates, days, months, etc.) that can be filled
automatically by Excel by dragging the + sign on right lower corner of cell.
• Re-molding or editing the data can be done in three
ways:
• Click on cell, then type the new data and click on Enter,
to overwrite previously written data.
• Double click on the cell where changes are to be made.
Blinking cursor appears, that can be moved around in
the cell to make changes.
• Go to the cell, and make changes in the formula bar.
Formatting Data in Worksheet
• To format data in one or multiple cells, use options under the ‘Font’ category in the ‘Home’ Menu.
• To select multiple cells, go to a cell. Hold the left click of mouse and then select other cells.
• Use Shift + Arrow keys to select multiple cells using keyboard.
• To select cells that are not continuous, use the Ctrl key and mouse.
• Change the font, font size and colour, and highlight text using options under ‘Font’ section in
Home Tab.
• Border can be applied to the cell using Borders option under ‘Font’ section.
• Under the ‘Alignment’ section in the ‘Home’ menu, text indentation can be changed within the
cell.
• Text alignment to either top, middle or bottom on the cell can be changed from Alignment section.
• Wrap Text: Used to wrap data into different lines so that the user can see all the data put in the
cell.
• Merge and Centre: To merge two or more cells to create a larger cell, generally done to give
labels in a table.
Adding Rows/ Columns
• To add rows:
• Select the row above which you want to insert a row. Right click on row number and select ‘Insert’.
• Alternatively, click on ‘Insert’ under ‘Cells’ tab in the ‘Home’ menu and select ‘Insert Sheet Rows’.

• To add columns:
• Select the column to the left of which column is to be inserted. Right click and select ‘Insert’ from the
menu.
• Alternatively, click on ‘Insert’ under ‘Cells’ tab in the ‘Home’ menu and select ‘Insert Sheet Columns’.

• ‘Insert Cells’ option:

• Used to insert cells or entire row or column.
• Select a cell. Go to Home > Insert > Insert Cells.
• A dialog box opens, displaying different options to insert cells by shifting selected cells right or down, as
well as inserting entire row or column.
Deleting Rows/ Columns
• To delete rows/ columns:
• Select the row/ column to be deleted. Right click and click on ‘Delete’ from the menu.
• Alternatively, select ‘Delete’ under ‘Cells’ tab in the ‘Home’ menu.

• User can hide a row/ column in case it is neither to be deleted nor shown.
• To hide a row/ column, select it and right click. Click on ‘Hide’ from the menu.
• When a row is hidden, its row number gets hidden and a light pair of lines can be seen.
• To unhide the row, go to the missing row number. The cursor changes to double-headed arrow, that can
be dragged fro row to appear.
• Alternatively, to unhide rows, select the rows above the below and hidden row(s). Right click and select
‘Unhide’ option from the menu.
Moving Cell Contents
To move cell contents:
• Drag and Drop
• Select the range of cells to be moved.
• Take cursor towards the border of the range and see it changes to move pointer ( ).
• Drag and drop it to the desired location.

• By Cut & Paste

• Select the range of cells to be moved.
• Use ‘Cut’ option from ‘Clipboard’ tab from ‘Home’ menu, or use keyboard shortcut Ctrl + X.
• The range of selected cells now has dark dashed border.
• Go to the desired location. Select ‘Paste’ option from ‘Home’ Menu or use keyboard shortcut Ctrl + V.
Copying Cell Contents
To copy cell contents:
• Select the range of cells to be copied.
• Use ‘Copy’ option either from
‘Clipboard’ tab from ‘Home’ menu,
or use keyboard shortcut Ctrl + C.
• Go to the desired location and select
‘Paste’ option from ‘Home’ Menu or
use keyboard shortcut Ctrl + V.
• Paste Special: It is an advanced
paste menu. After the selected data is
copied, click on Ctrl + Alt + V. This
opens the ‘Paste Special’ dialog box.
• Paste Special can be used to paste
either only values, or formulae, and
even formats.
Changing Column Width/ Row height
• To change row height:
• Select the row(s). Click on ‘Format’ under Cell tab in Home Menu.
• Click on Row Height. Put desired value and click on OK.
• To change column width:
• Select the column(s). Click on ‘Format’ under Cell tab in the Home Menu.
• Click on Column Width. Put desired value and click on OK.
• To change row height/ column width automatically, choose AutoFit Row
Height/ AutoFit Column Width in the Format Menu.
• To resize all columns and rows:
• Click on ‘Select All’ button at the top left corner, below the cell address box.
• Drag any row or column boundary to resize all equally.
• To resize the rows and columns according to the data in the cells, double click on
any boundary when the pointer changes to a double-headed arrow.
Filtering & Sorting Data
• Sorting helps to arrange the data set in ascending or descending order.
• Filtering means to filter values, i.e. choose the values as per criterion.
• Steps to apply filter to a set of data:
• Select data, and use keyboard shortcut: Ctrl + Shift
+ L.
• Alternatively, after selecting data, click on ‘Sort and
Filter’ in the ‘Home’ menu, OR select ‘Filter’ from
‘Data’ menu.
• After filter is applied, column header arrow ( )
appears.
• Number or Text filters can be selected, or manual
check the values as per requirement.
• To sort data, click on the arrow, and choose ‘Sort A
to Z’ to arrange the selected data in ascending order
and vice-versa.
Overview of Formulae in Excel
• Excel used to process input data accurately and conveniently for data analysis for research studies,
business plans, etc.
• In Excel, a formula is used to operate on data to get results.
• Formula begins with equals to sign (=) in a cell.
• For e.g. to add two numbers in A12 and A13, write ‘=A12+A13’ or ‘=SUM(A12, A13)’ or ‘=SUM(A12:A13)’.
• Arguments used in the formulae are shown in Excel when user begins typing the formula.
• Some commonly used formulae are also given under ‘Formulas’ menu.
Inserting Illustrations/ Charts
• Illustrations (or charts) help present analysis or results graphically.
• Multiple types of charts in Excel are: Bar Chart, Column Chart, Radar Chart, Pie-chart, Line Chart
and Area Chart.
• Multiple charts can be combined & trend
lines can be generated.
• Steps to insert & modify charts:
• Enter data in the worksheet.
• Select the data.
• Go to ‘Insert’ menu > ‘Charts’ tab. Select
suitable type of chart.
• Values can be filtered in chart using filter
option that appears on the boundary.
• Charts can be customized by adding
elements or styling using chart styles or
quick layouts under ‘Design’ tab.
Creating a Pivot Table
• Pivot Table is a summary table for the data.
• Powerful feature in Excel to perform operations on the data
along with summarizing it
• Pivot Table helps identify trends, and see comparisons and
patterns.
• To insert a Pivot Table:
• Select the data that needs to be analysed.
• Go to Insert Menu > Pivot Table.
• A dialog box opens that shows the selected data and destination
for inserting the Pivot Table.
• When you click on OK, it opens a ‘PivotTable Fields’ window on
the side.
• Choose the fields for Rows/ Columns/ Values/ Filter as per
requirement.
• Pivot Table can be customized further to identify trends.
Saving & Closing a Workbook
• Steps to save Workbook in computer:
• Click on ‘File’ Menu > ‘Save’. Alternatively, click on Save Icon in the Quick Access Toolbar, or use
shortcut keys: Ctrl + S.
• Choose ‘Computer’ > ‘Browse’ to select a location on the system.
• ‘Save as’ dialog box opens. Navigate to the desired location to save the file.
• Type the name in ‘File Name’ field and click on ‘Save’.
• ‘Save As’ is another option used to save a file in a different location or format:
• Click on ‘File’ Menu > ‘Save As’.
• ‘Save As’ dialog box opens. Select the desired location to save the file.
• Select the desired format (PDF, etc.) using ‘Save as type’ option below the ‘File Name’ option.
• To close a Workbook:
• Go to ‘File’ Menu > ‘Close, or click on ‘Close’ button in Windows Control on top right.
• In case the Workbook has any unsaved changes, Excel prompts to save those before closing and exiting.
• To open an already saved Excel file, go to File > Open. Go to the location where the file is saved
and click on it to open.
Printing a Worksheet
Steps to print an Excel Workbook:
• Go to ‘File’ menu > ‘Print’. Alternatively, you can use keyboard shortcut Ctrl + P.
• Select sheets to be printed.
• Printer settings page opens, where settings can be changed for:
• Print on one or both sides of the page.
• Collated pages or uncollated in case of multiple copies.
• Orientation (landscape or portrait)
• Margins
• User can see how the sheet will look like on the right side of the settings.
• Specify the number of copies required and click on ‘Print’ command at the top.
Summary
• MS Excel is a spreadsheet application that helps in calculation (e.g., addition, average, standard
deviation, trigonometric functions), graphing (charts, graphs, and reports), pivot tables
(summarizing data), etc.
• MS Excel can be used to store, recover, and retrieve data as well as filter required information. It is
also convenient to share data and analysis for other people’s reference and collaboration.
• MS Excel has rows and columns layout. Data is entered in cells.
• Data can be formatted in Excel. Rows and Columns can be resized or hidden as per need.
• Data can be filtered and sorted.
• Formulae are used to operate on data.
• Charts/ Illustrations can be added in Excel to graphically present the results.
• Pivot Table can be used to get summary of the data.
 Chapter – 6

Introduction to
Microsoft PowerPoint
Arashgeet Kaur
Learning Objectives
• To understand basic features of Microsoft PowerPoint.
• To demonstrate the use of MS PowerPoint.
• To create a presentation.
• To add images and illustrations in slides.
• To effectively handle transitions within and between slides.
• To present the presentation to an audience.
Chapter Outline
• Introduction to MS PowerPoint
• Creating a Presentation
• Adding a Slide
• Adding and Formatting the Data
• Adding table, pictures and charts in a Slide
• Saving a Presentation
• Designing a Presentation
• Applying transition to the Slides
• Applying animation to objects in the Slide
• Presenting a Presentation
• Printing the Slides
Introduction to Microsoft PowerPoint
• Microsoft PowerPoint is used to make presentations for personal and professional
use.
• It was released in April 1987 by Forethought, Inc. and was acquired by Microsoft
3 months later.
• MS PowerPoint has features to add information, images, charts and videos in
multiple slides.
• MS PowerPoint offers processing, drawing, graphing and presentation
management tools.
• Transitions and animation effects can be added to make the whole presentation
look more appealing to the audience.
Creating a Presentation
• Go to Start Menu > Programs > Microsoft Office > Microsoft PowerPoint.
• Once MS PowerPoint is open, select Blank Presentation to create a presentation
from scratch.
Adding a Slide
• User sees a slide (Title slide by default)
when blank presentation is opened.
• To add another slide in the presentation:
• Go to Home > New Slide
• By using keyboard shortcut ‘Ctrl + M’
• Click on New Slide icon adds a ‘Title
and Content’ slide by default.
• To add a slide of different layout, go to
‘New Slide’ drop-down and choose as
required.
• Use ‘Layout’ option (next to New Slide
icon) to change the layout of an existing
slide.
Adding & Formatting Data
• To add data, click on text box and start typing.
• Data can be formatted by selecting and
choosing desired options under ‘Font’ section
in Home Menu:
• Font style
• Font size
• Text appearance: Darker using B, slanting using I,
underlined using U, strike through middle using abc
• Font colour
• You can add bullets or numbering to text from
Paragraph category in the Home Menu.
• Under the ‘Paragraph’ category, you can
change text direction, align text & convert text
to SmartArt.
Adding & Formatting Data
• Under the ‘Drawing’ category in Home Menu, there are several other formatting options:

Quick Style option for text box formatting Shape Fill option under Home Menu

Shape Outline option under Home Menu Shape Effects option under Home Menu
Adding Table, Pictures & Charts
• PowerPoint helps to add illustrations for more effective presentation.
• To insert the illustrations, use various options under ‘Insert’ Menu.
• You can also insert images in the slide by copying & pasting from anywhere in computer
• SmartArt Graphics are used to communicate information (e.g. list, life cycle, hierarchy, etc.)
• Charts are used to display numerical data into graphical form for easy interpretation
‘Insert’ Tab
Features under the ‘Insert’ Tab are listed below:
• Header & Footer – Used to add data that appears
on the top (Header) and at the bottom (Footer) of
every slide.
• Date & Time – Used to insert the date and time on
all slides.
• Slide Number – Used to insert slide number at the
bottom of the slide.
• Object – Used to embed other files within the
presentation that the presented might have to refer
to clarify to the audience.
• Video – Used to insert video into the slide, either
saved in the computer or directly from online.
• Audio – Used to add music or any audio clip saved
on computer or online, or to record audio for a
slide.
Saving a Presentation
Steps to save a presentation:
• Click on File > Save, or Click on Save Icon above the Menu Bar, or use shortcut keys: Ctrl + S.
• Choose ‘Computer’ > ‘Browse’ > Navigate to the desired location to save your file.
• Type the name in ‘File Name’ field and Click on ‘Save’ in the dialog box.
• To save a file in a different location or format, go to ‘Save As’ > Computer & follow the same
steps.
Designing a Presentation
• PowerPoint has various themes that can be used to change the slides appearance
• User can change the background colour or add texture, change font styles, or add borders
• Themes can be found in ‘Design’ Tab.
Applying Transitions to Slides
• Transition is the effect while switching
between slides.
• Steps to apply transition are as below:
• Go to the slide to apply the effect to.
• Go to ‘Transitions’ Tab > Select an effect.
• User can also time and add sound effects
to the transition under Timing section in
Transition Tab.
• For same transition effects on all slides,
click on ‘Apply To All’.
• For different transition effects, go to
slides and apply the desired transition
effects.
• Select ‘Preview’ option to see how the
transition would look.
Applying Animation to Objects in a Slide
• Animation can be used to put up data one by
one on the slide if there is multitude of data.
• To animate any object (text or graphics), follow
the below steps:
• Select the object to be animated
• Go to ‘Animations’ tab > select an Animation
effect
• To apply multiple animations on the same
object, use ‘Add Animation’ under Advanced
Animation section in the Animations Tab
• To remove animation from a particular object:
• Select the object.
• Go to Animations Tab > select ‘None’.
 Presenting the Presentation
• Presentation is often used as an aid to deliver a lecture, present a case-study or research work,
demonstrate a process, etc.
• To start a slide show, follow the steps below:
• Go to ‘Slide Show’ Tab > Select ‘From Beginning’ to start
displaying the slides on full screen mode from the first side.
• To start the slide show from any other slide, click on that slide
and the select ‘From Current Slide’ under the Slide Show Menu.
• Alternatively, click on Slide Show icon below the slide, besides
the Zoom option.
• User can use Speaker Notes for assistance on the content
displayed on the slide.
• Click on ‘Notes’ below the desired slide and type the notes.
• To see the speaker’s notes while presenting the slide show, right
click and select ‘Presenter View’.
• Presenter View shows the notes on the speaker’s screen only,
while the audience sees the slides only in full screen.
Presentation Views
• Normal View: The default view, that has thumbnails on left and the selected slide is open. This is
used mostly while preparing the presentation.
• Outline View: Text appears on the left instead of thumbnails that helps identify the outline of the
presentation. It can be used to create presentation by directly copying and pasting contents in
similar format from a Word File.
• Slide Sorter View: Only slide thumbnails are seen, and this view is used to re-arrange slides
conveniently.
• Notes Page: This view shows the slide along with speaker notes.
• Reading View: Similar to Slideshow, this view is used to check transitions & animations on the
slides.
• Master Views: This section contains Slide Master, Handout Master and Notes Master. The changes
made in master view are applied to all the slides automatically.
Printing the Slides
Steps to print the PowerPoint slides:
• Go to ‘File’ menu > ‘Print’. Alternatively, you can use keyboard shortcut Ctrl + P.
• Select the slides to be printed.
• Printer settings page opens, where settings can be changed for:
• Print on one or both sides of the page.
• Collated pages or uncollated in case of multiple copies.
• Orientation (landscape or portrait)
• Margins
• Print Layout can also be chosen, whether to print the slides, notes hand out page or the outline
view.
• User can see how the slides printout will look on the right side of the settings.
• Specify the number of copies required and click on ‘Print’ command at the top.
Summary
• PowerPoint is a software used to create presentations for both professional and personal use.
• User can add multiple slides and select the layout for each to suit the purpose or message to be
delivered via that slide.
• Data and illustrations can be conveniently added and formatted.
• User can also insert header & footer, date & time, and slide numbers on the presentation.
• The objects on the slides can be animated to make the presentation more appealing.
• PowerPoint also has transition effects for slides.
• Slide Show feature is used to present the slides to the audience while the speaker has options to
view the presenter notes in the Presenter View.
• The slides can be saved and printed as desired by the user.
 Chapter – 7

Use of Internet & Email

Arashgeet Kaur
Learning Objectives
• To understand the basics of internet
• To demonstrate the use of internet
• To demonstrate the use of email
Chapter Outline
• Introduction to Network and its types
• Introduction to the Internet
• Features of Internet
• Components of Internet
• Web
• Introduction to Email
• Composing/ Replying/ Forwarding an Email
• Significance of Communication Software in Nursing
• Using Zoom for Audio & Video Conferencing
 Network
• Networking: Practice of transporting & exchanging data in an information system.
• Networking includes design and construction of network, management and maintenance of the
network infrastructure and software as per policies.
• Network: Consists of multiple computers linked to each other to exchange files, share resources
and allow electronic communications.
• Three types of computer network (mostly determined through distance):

WAN (Wide Area Network)

LAN (Local Area Network) MAN (Metropolitan Area Network) Multiple interconnected LANs/ MANs,
Network spread of less than 5 km Network spread within 25 km and communicate via telephone lines or
radio waves
Introduction to Internet
• ‘Internet’ – The “network of networks”, is the worldwide computer network.
• Internet is made of two words: Inter + Net, i.e. interconnected networks.
• Internet helps to search and share information for educational, research & entertainment purposes.
• Internet uses a protocol called Internet Protocol Suite (TCP/IP) to link computers around the world.
• Internet was developed by Robert Cahn and Vinton Cerf in the late 1970s.
• ARPANET (Advanced Research Projects Agency Network) was the first known group of the
interconnected computers, funded by the US Department of Defence, to transfer confidential data
between the Military.
• Cahn and Cerf developed TCP/IP (Transmission Control Protocol and Internet Protocol), i.e. a
communication model that set standards for transmission of data between multiple networks.
• Internet was fully commercialized in the US by 1995.
• WWW (World Wide Web) was invented by Tim Berners-Lee and was opened to public in 1991 .
• WWW is the most common means of accessing data online, in the form of websites.
Features of Internet
• Accessibility – Internet is a global service and is accessible to everyone.
• Variety – Internet consists of multimedia data, i.e. text, images, videos, etc.
• Easy to Use – Internet can be accessed using laptops or smartphones via web browsers that are
easy to learn and use.
• Universal – Internet works with the same technology throughout the world.
• Flexibility to Communicate – Communication via the internet (chat via text, video call, voice call,
etc.) is quite flexible, convenient and effective.
• Versatility – Internet is used vastly in all the sectors such as education, nursing, e-commerce and
many more.
Components of Internet
• Internet Service Provider (ISP): Basic requirement for accessing the internet. Different ISP use
different internet speeds, measured in MBPS (megabits per second) in their connection.
• Clients: A computer system that can access the stored information or data on the server.
• Server: A computer program (hardware or software) that provides service to clients, and is
required to transfer data through the internet and manage network resources.
• Connection Devices: Devices (laptops, mobile phones, etc.) required to access the internet, which
need to be compatible to be able to load web pages.
• Modem: Combination of two words: MOdulator – DEModulator. It is hardware for an internet
connection that has a slot to insert telephone line. It converts telephone line analog signal to
computer digital signal.
• Router: It routes data between devices. It allows all wired and wireless devices to use the internet
connection simultaneously and allows them to connect with one another without having to do it
over the internet.
 Components of Internet… Contd.
• Internet Connectivity: Means of delivery of the internet. Several ways of internet connectivity are
listed below:
Dial-up Connectivity: It uses telephone line to connect PC to Integrated Services Digital Network (ISDN): Internet
the internet via modem. It is usually set up at home or for connection is established using phone lines carrying digital
small business owners. signals, instead of analog signals.

Digital Subscriber Line (DSL): It provides connection over Cable Connectivity: It uses a coaxial cable TV line and a
telephone lines. Several types of DSL connection techniques cable modem to access internet, and can transfer data at a
are available, that differ in level of service. higher speed than telephone line.

Wireless Connectivity: It uses radio frequency bands to

connect to the internet, either by using a WiFi or Bluetooth,
and offers a very high speed
Working of Internet
• Internet is a global network of computers, where each connected computer has a unique ‘IP’ address.
• IP Address is in the form of [Link], where nnn is a number from 0-255.
• A temporary IP address is assigned to the computer when it is connected to the internet.

• To communicate with another connected computer, a message is transmitted by this process:

• The sender sends the message via an application on the computer connected to the internet.
• The message passes to TCP/IP protocol. For a long message, it is broken into small chunks of data called ‘Packets’.
Each packet is assigned a Port Number, while continuing to the TCP layer.
• After TCP, packets proceed to IP layer, where they receive the destination computer’s IP address.
• The hardware turns the packets, with port number & IP address, into
electronic signals and transmits them over the phone line.
• At the receiver’s end, router examines the destination IP address and
determines where it is to be sent.
• Packets reach the destination computer, and go through the TCP/IP protocol –
First through the IP and then TCP layer.
• As the data reaches the application, all the packets have been re-assembled to
read the original message.
Web
• Web Page: Hypertext document provided by a website and displayed to user in a web browser. It is identified by a distinct
URL (Uniform Resource Locator). A web page is made up of HTML (Hypertext Markup Language) text files, CSS, etc.

• Website: A collection of web pages and related content. It is identified by a common domain name and is published on web
server. For e.g. [Link], [Link], etc.

• WWW (World Wide Web): Leading information retrieval service of the Internet.

• Web Server: A computer software and hardware that uses HTTP (Hypertext Transfer Protocol) and other protocols to
respond to client requests made over WWW. It is a part of larger package of internet and intranet related programs. It is
used for sending and receiving mails, building and publishing webpages.

• Web Browser: An application software for accessing the World Wide Web. It retrieves necessary data from the server and
displays on the user’s device. For e.g. Google Chrome, Mozilla Firefox, etc.

• Search Engine: A website that provides links to other websites and helps search the World Wide Web in systematic way for
particular information specified in the keywords. For e.g. Google, Bing, etc.

• Key Words: Most relevant words or phrase that are entered in a search engine to search files, websites, etc.

• Home Page: The introductory page of website used by the people visiting the website to navigate through its contents.
Searching content on the Internet
• A user needs working internet connection on a
compatible device to access the internet & search relevant
content:
• Open web browser. For e.g. ‘Internet’ browser in Android
phones, ‘Safari’ in iOS devices, Google Chrome and
Microsoft Edge in laptops, etc.
• Search bar is available on top of the browser.
• Type in the website address directly to go to that website.
• If exact web address is not known, use key words in the
search bar, that is input for search engine.
• The search engine being used by the browser can be
changed in the settings.
• When a keyword is entered, a software called ‘Spider’
searches and lists the web pages within fraction of a
second, called ‘Hit’. Each search engine has different types
of spiders.
• User can also browse through images, videos, news and
maps, etc. using the search engine.
Introduction to Email
• Shortened form of ‘electronic mail’
• Email is the electronic way of sending the mail.
• Email revolutionized the process of communication as it took no time to be delivered.
• A user needs to have a compatible device, a working internet connection, an email address and the
data to be sent via an email.
Making an Email Account
• An email address consists of two parts: a username, i.e. unique to everyone, and a domain name,
separated by ‘@’. For e.g., anm213452@[Link]
• Username can consist of alphabets, numbers and special characters.
• To create an email account, follow the steps given below:
• Open web browser (e.g. Mozilla Firefox, Google Chrome, etc.) and
type [Link].
• Click on ‘Create Account’. Select to create an account for yourself on
the popup.
• A window appears asking for the First name, Last name, Username,
Password, confirmation password, etc.
• A unique username needs to be chosen.
• After entering all the details, click on ‘Next’.
• After accepting ‘Privacy and Terms’ and verification, welcome page
appears.
• After you continue, Inbox appears.
Features of Email
• Profile can be customized by changing profile picture and themes, and adding a contact number.
• The left pane shows options to compose an email and various folders in the account.
• Google Meet options are seen below the folders, i.e. New Meeting and Join a Meeting. Google
Meet is software used for communication.
• ‘Hangouts’ chat option is used for instant messaging.
• On the top, search bar is used to search for an email by either specifying the sender or keywords.
• On the top right, there are options for Support, Settings, Google Apps and your profile.
Composing an Email
• To compose a mail, follow the steps given below:
• Open web browser and go to Gmail. Sign in to Gmail account using username and password.
• Click on Compose. A pop up opens.
• Add email ID of the recipient(s) in the "To" field.
• You can also add recipients in the "Cc" (Carbon Copy) and
"Bcc" for (Blind Carbon Copy).
• ‘Subject’ summarizes the email contents clearly and concisely
and contains the keywords from the email body.
• Blank area below the subject line is designated space for
writing message in detail. It also has options for changing text
colour, font, size and highlight & adding bullets, etc.
• A signature is added at the to specify your name, designation
and contact details.
• Signatures can be saved in Settings to avoid writing it at the end
of every mail.
Composing an Email… Contd.
• At the bottom of the email window, there are several options along with Send:
• Formatting Options: Used to show or hide the formatting options to modify text, change colour and
font while writing a mail.
• Attachment: Used to attach files in the email available on the computer system. The maximum limit that
can be shared over Gmail is 25MB.
• Insert Link: Used to insert a link in the mail.
• Insert Emoji: Used to insert emoji, i.e. pictograms used in electronic messages, to express emotions.
• Google Drive: Used to insert files from Google Drive or files greater than 25 MB that cannot be attached
directly in the email.
• Insert Photo: Used to attach picture(s) in the mail, either from Google Drive, computer system or Web.
• Confidential Mode: Used to turn confidential mode on or off. When this mode is turned on, the
recipient cannot forward, copy, print or download the email.
• Insert Signature: Allows the user to manage signatures, i.e. to edit or add multiple signatures. Generally
used in organizations to understand the designation of senders & recipients.
• Discard: Used to discard the draft of email, that gets automatically saved while typing an email.
Replying to Email
• Emails from work often require the recipient to acknowledge or reply to the email.
• It is ideal for the sender and recipient if the conversation is continued as a thread to keep a check
on the occurrences and timeline.
• To reply to an email, follow the steps mentioned below:
• Open the email to which you need to reply.
• Click on ‘Reply’ on the bottom left or arrow on the top
right. That opens a pop-up window to write a reply.
• After typing in the reply, click on Send.
• To change email subject, click on arrow on the top left
corner of the pop up window.
• In case of multiple recipients in ‘To’ and ‘Cc’ field, there
are two options:
• ‘Reply’ keeps only the recipients in ‘To’ field.
• ‘Reply All’ keeps all the recipients from both the ‘To’ and
‘Cc’ fields.
Forwarding an Email
• Forwarding an email is similar to replying to an email.
• To forward the email, click on Forward at the bottom or click on Forward from the Menu option.
• When you click on Forward, a pop-up window appears.
• Add recipients in the ‘To’ and ‘Cc’ fields.
• Sender can also add message and attachments in addition to the email you are forwarding.
Folders in the Gmail Account
• Inbox: The emails are received in the inbox. The new and unread emails are highlighted in the Bold.
• Primary – Receives emails from individuals.
• Social – Receives emails from social networks, such as Facebook, Instagram, Linkedin, etc.
• Promotions – Receives emails regarding deals, offers & other promotional emails from shopping
websites, etc.
• Updates – Receives emails from websites with updates, such as orders from shopping websites, etc.
• Starred: Contains important emails, marked by a yellow ‘star’, appear in this folder.
• Important: Contains priority emails, marked by ‘Important’.
• Sent: Contains the emails sent successfully. In case, the mail is not sent, it is in the Outbox folder.
• Drafts: Contains emails that sender is still working on, or is yet to send. An email on which sender is working
gets automatically saved in Drafts. It can be edited in the future and saved.
• Spam: Contains emails with suspicious or malicious links that are sent directly to Spam instead of Inbox.
• Bin: Contains the emails that have been deleted. It can be used to recover the emails that have been accidently
deleted. In case the emails are not cleared from the Bin, they are deleted automatically after thirty days.
• All Mail: This folder contains all the emails, irrespective of the folder category.
Significance of Communication Software
• Internet is widely used as a communication tool all around the world.
• People can video chat, use audio calls, and do instant messaging over the internet.
• Some commonly used communication software are Skype, Zoom, WhatsApp, etc.
• Significance of communication software in nursing:
• Possible to attend Conferences & Events happening anywhere in the world
• Easy for organizers to invite presenters for conferences virtually anywhere
• Multiple software available for aiding teaching of nursing students
• Nurses can access content and learn new skills as per their convenience & requirement
• Enables booking appointment & consultation from specialized doctors where physical visits are difficult
for the patients
Using Zoom for Audio/ Video Conferencing
• After you download the Zoom software and launch it, a screen
appears with options to join a meeting or to sign in.
• User can directly join a Zoom meeting if he has the meeting
details, i.e. a unique meeting ID and a password shared by host.
• User can also make a Zoom account after selecting Sign In
Option.
• Once a user is signed in and has started a meeting, or has joined
the meeting as a guest, he can see several options: Mute mic,
Start/ Stop Video, Chat, Share Screen, etc.
Summary
• Email and Communication programs hold significance in the field of nursing and healthcare.
• Internet is the ‘Network of Networks’ and is fast gaining popularity as the medium of sharing
information and communication.
• The internet works on TCP/IP protocol.
• The internet can be used to search information in fraction of seconds.
• Internet also has applications to chat online in real-time and send both formal and informal
communication.
• In the field of nursing, the communication software are used for attending events virtually as well
as learning new skills.
 Chapter – 9

Statistical Packages
Arashgeet Kaur
Learning Objectives
• To understand a statistical package
• To understand basic features of a statistical package
• To describe and use statistical package
Chapter Outline
• Importance of Statistics for Nurses
• Introduction to Statistical packages
• Types of Software
• Features of Statistical Packages
Importance of Statistics for Nurses
• Statistical analysis: Science of collecting, exploring and presenting large amounts of data to
discover trends and underlying patterns.
• Statistical software: Specialized computer program for statistical analysis to help the user make
more observed decisions, uncover opportunities, increase revenue and eventually profits.
• Nurses need to understand the basic statistical terminology (mean, mode, median, etc.) & concepts
(reliability, statistical significance, etc.) while reviewing a research article in a medical journal.
• Importance of Statistics for nurses:
• Advanced career positions, such as nursing professor/ manager require knowledge of statistics.
• Important to design studies to measure specific variables for nursing and healthcare research.
• Used to interpret medical research findings, report the findings and understand their statistical
significance.
• Helps nurses recognize and understand trends in healthcare data, resulting in cost savings and
improvement in healthcare.
• Used to identify specific patterns in signs & symptoms to help nurses respond better to any medical
change in the patient.
Types of Statistical Software
Open – source Software Public Domain Software
These software give access to source code. Their These software have no ownership & thus no
license doesn’t restrict software distribution or copyright, trademark or patent. These can be
require a royalty or fee for sale. modified and distributed freely.
Examples: R, Chronux, LibreOffice Calc, PSPP, Examples: CSPro and Epi Info.
etc.

Freeware Proprietary Software

This software is distributed for free of cost to the This is copyrighted & is restricted for usage,
end user, but generally the source code is not distribution and modification by its vendor.
made available.
Examples: SPSS, MATLAB, MS Excel, SAS,
Examples: MaxStat Lite, Winpepi, etc. STATA, Statistica, MedCalc, Minitab, etc.
Statistical Packages & their Features
This section discusses the features of several proprietary & free software packages:
• Proprietary packages
• Microsoft Excel
• SPSS
• Minitab
• SAS
• STATA
• Free software packages
• Libre Office Calc
• PSPP
• Epi Info
• R
MS Excel
MS-Excel is a spreadsheet program used to record, maintain and analyse data. It helps in calculation
(e.g., addition, average, trigonometric functions), graphing (charts, graphs, reports), pivot tables
(summarizing data), etc.

Merits Demerits
• Ease of use: It is easy to use and can be • Primarily designed for financial calculations,
interchanged well with other programs of though it can be used for multiple things.
Microsoft Office Suite.
• Additional add-ons are required to make more
• Compatibility: MS Excel worksheets can be sophisticated statistical analysis.
read by many other statistical packages.
• Illustrations: Excel can produce nice
illustrations (such as charts, graphs, etc.)
SPSS (Statistical Package for the Social Sciences)
SPSS is a powerful tool for data analysis and helps creating reports of data in form of graphical
presentations that can be used for publishing and reporting. It is commonly used in healthcare
industry to support medical research, improve disease management, and monitor patient care.

Merits Demerits
• User friendly: SPSS is easy to learn and use. • Focuses mainly on statistical methods used in
• Good Data management: Easier and quicker social sciences and market research.
as it knows location of the cases & variables. • Expensive to purchase for students.
• Suitable for Report Generation: Rich graphics
that helps to easily interpret results. • Usually additional training is required to
understand all the available features.
• Compatibility: It can be used either with menu
or syntax files.
• Comprehensive Statistics: ANOVA, Frequency
– distribution, correlation, etc. can be
performed easily.
• Wide Scope: Functionality such as predictive
modelling, trend analysis, ML algorithms, etc.
Minitab
Minitab, developed in 1972, offers a range of both basic and fairly advanced statistical tools for data
analysis. It helps organizations in healthcare to maximize the quality of care, maximize cost savings
and ensure safety using data analysis and smart process management.

Merits Demerits
• User friendly: Easy to use tools for data • Minitab cannot perform complicated statistical
analysis even without advanced knowledge of calculations and data analysis, and is also cost
consuming.
statistics.
• Basic data analysis: Easy to use for basic tests
such as ANOVA, Chi-Square Test, T-Test, etc.
• Compatibility: Excel file can be easily
imported in Minitab or cells can be copied and
pasted.
• Graphical output: It gives output in the form
of graphs that makes it easy to interpret
results.
SAS (Statistical Analysis System)
SAS, developed in 1966, is used in clinical trials. It is used for data management, advanced analytics,
business intelligence and predictive analysis. It offers options to use GUI and more through SAS
Language.

Merits Demerits
• Easy to learn: SAS syntax can be learnt • SAS has a complex design and thus is harder
without any programming skills. to learn and use than SPSS.
• Data management: It can handle large • SAS is costly and a license is required to
database easily. access all applications.
• Graphical representation: Graphs like box
plots, scatter plots, bar charts, etc. can assist in
result interpretation.
• Wide Scope: It provides balanced design and
modelling environment in ANOVA, cluster
analysis, distribution and discriminant
analysis.
STATA
STATA, released in 1985, is popular in the field of economics and political science. It also has GUI
and command line function.

Merits Demerits
• User friendly: Command line functions have • STATA is limited to certain types of data only.
easy-to-learn syntax. • It is harder to learn as compared to SPSS.
• Compatibility: It can import data in a variety • New functions cannot be programmed into
of formats, such as .csv and .xls format. STATA.
• Powerful: More powerful than SPSS, and is
useful for advanced regression modelling.
• Customized Graphics: Custom graphs can be
created and exported to different formats for
the purpose of publication.
LibreOffice Calc
LibreOffice Suite, released in 2011, is free and open-source office productivity software. LibreOffice
Calc is the free spreadsheet program.

Merits Demerits
• Cost: Free to download. • LibreOffice Calc does not have as many
comprehensive features as MS Excel to
• User friendly: Similar to Excel, easy to use.
perform advanced statistical functions.
• Basic Functions: Efficient to perform basic
mathematical operations & statistical
functions.
• Graphical Results: 2D &3D charts generated
to help interpret results, and can also be
integrated with other programs.
• Compatibility: Can open, read and edit files
with .xls and .csv format, i.e. MS Excel files,
among other file formats.
PSPP
PSPP, launched in 1990s, is used for statistical analysis of sampled data. It is similar to SPSS. It is a
stable and reliable application. PSPP can be used with its GUI or more traditional syntax commands.

Merits Demerits
• Cost: No license fee & free to download. • PSPP has limited graphic functions as
compared to SPSS.
• Compatibility: Inter-operable with free
software: LibreOffice, OpenOffice, etc. • PSPP is not suitable for conducting advanced
statistical operations.
• Basic operations: Descriptive statistics, T-test,
ANOVA, linear and logistic regression, etc.
can be performed.
• Superior performance: Can perform fast
statistical procedures for even large data set.
• Varied outputs: Output can be text, pdf, open
document or html as required.
Epi Info
Epi Info, developed by CDC, allows survey creation, data entry and analysis with epidemiologic
statistics, maps and graphs for public health professionals. It is used for outbreak investigations and
for developing small to mid-sized disease surveillance systems.
Merits Demerits
• Different Operations: Classical statistical • Epi Info can be difficult to learn.
analysis & advanced processes such as • It does not have very broad scope for
Logistic Regression can be performed. advanced analysis and modelling.
• Compatibility: Program is compatible with MS
Access & other SQL databases; Output is
compatible as HTML web pages.
• Designing Forms: The ‘Enter’ and ‘Form
Designer’ module are used to design survey,
modify the data entry process & collect data.
• Data Packager: It has ability to merge data
from multiple users into a single database for
analysis, as well as share data with other users.
CDC – Centre for Disease Control and Prevention
R (R Foundation for Statistical Computing)
R, released in 1993, is a popular programming language and a widely used free statistical software
package for statistical modelling and analysis. It requires a certain degree of coding.

Merits Demerits
• Cost: License is not required to work on R. • R is difficult to learn for people who have had
no prior coding experience.
• Compatibility: Platform-independent language
and is compatible with Windows & Mac OS.
• Comprehensive: Most comprehensive
statistical analysis package & incorporates
statistical tests, models and analysis.
• Advanced Statistics: It has advanced statistical
functions.
• Superior Graphical capabilities: Provides
fully programmable graphics that are better
than other available packages.
Features of Statistical Packages
• Wide Scope: Statistical packages are used in healthcare industry, finance, engineering, and other
fields that require statistical analysis for making informed decisions.
• Efficient: Statistical packages are highly efficient and accurate. They calculate results far more
efficiently than manual calculation.
• High Performance: Statistical packages work on advanced statistical techniques for data analysis
and hence deliver high performance.
• Data based Results: Advanced statistical techniques are used to process and analyse the collected
data to make decisions. This helps in practical situations, to face challenges or make informed
decisions based on concrete parameters.
• Graphic Visualization: Graphical results are presented to help user visualize and interpret the
results. This also helps in better report writing or publishing the study.
• Storage: Statistical packages have enough storage to save and analyse multiple variables, which
may go up to more than thousands for advanced studies.
Summary
• Statistical analysis is the science of collecting, exploring and presenting large amounts of data to
discover trends and underlying patterns.
• Computational statistics grew and became widely accepted due to inaccuracies when manual
process of sampling and interpreting results was done.
• Statistical packages are either free to download and use (i.e. Open-source, Public domain or
freeware), or required to be purchased (e.g. Proprietary).
• The statistical packages are efficient, high performing, help visualizing results and making
informed decisions.
 Chapter – 10

Hospital Management System

Arashgeet Kaur
Learning Objectives
• To understand the types of Hospital Management System.
• To describe the use of Hospital Management System.
Chapter Outline
• Objectives of Hospital Management Information System
• Types of Healthcare software
• Components of Hospital Management Information System
• Uses of Hospital Management Information System
Introduction to HMS
• Health care system requires rational and effective management.
• Hospital Management System (HMS) provides an easy way to manage hundreds of operations
running parallel in the hospital.
• HMS provides a unified view for managing patients, doctors and appointments, billing
information, finances, inventory and much more.
• HMS increases the efficiency of the process and allows hospitals to provide quality service in
addition to professional medical care.
• HMS is typically a computer-based software system that helps manage the various complicated
processes and workflows essential for the regular working of a hospital.
• HMS provides interfaces for the various stakeholders of a hospital to capture, access, manage and
report information about every single aspect of the hospital’s functioning.
Objectives of HMS
• Hospital Management System is aimed to maintain day-to-day activities of hospital.
• HMS is designed to achieve the following objectives:
• To computerize all the details regarding patients and hospital.
• Scheduling the appointments of the patients with doctors.
• Scheduling the services of specialized persons, doctors and emergencies properly.
• To increase the utilization of facilities provided by hospital in efficient manner.
• To manage the inventory of the drug store of the hospital.
• To handle laboratory and pathological reports of the hospital in a perfect manner.
• Updating inventory automatically after a transaction is made.
• To keep information of the patients and their records update for future use.
Components of HMS
• Eleven different components of the Hospital Management System discussed ahead:
• Appointment management
• Patient Management
• Facility Management
• Staff Management
• Supply Management
• Financial management
• Insurance Management
• Laboratory Management
• Radiology Management
• Report Management
• Support Management
Appointment Management
• Patients take prior appointment to avoid
hassle.
• HMS assigns patients to the specialist
available, or the one that they prefer.
• For assigning patient to specialist, HMS
matches the patient’s illness to the doctor’s
area of expertise.
• HMS checks doctors’ availability for
remote visit in case patient needs medical
care at his house.
• HMS is convenient and saves time of both
patient and Health care provider by
matching requirement & availability.
Patient Management
• HMS helps register complete patient information starting from the appointment till the relieving
from the hospital.
• HMS captures and stores the medical history, treatment required, details of previous visits,
upcoming appointments if any, reports, insurance details and other things.
• Benefits of Patient Management module:
• HMS saves time by eliminating the need to get the same details on every visit.
• Health care providers can concentrate on comprehensive care of the patient as every detail is easily
available.
• It enables doctor to focus more on the treatment.
• It also improves the patient experience.
Facility Management
• Every health care facility needs to maintain records of bed availability, occupancy status of rooms
with specialized care and more.
• HMS has all information related to availability in the facility and makes it readily available
whenever required.
• The hospital receptionist can check the facility information from HMS and convey it to those who
seek it.
• HMS helps the administrators to make the strategies for further expansion & expedition according
to the need of the hospital.
Staff Management
• The staff management module lays a concrete solution to the HR organization in the hospital.
• It contains records of the medical, para medical and supporting staff, their job description, their
service domain, and other vital details.
• It helps managers and administrators to know their staff information and availability at few clicks.
• It enables managers to plan recruiting process based on the requirement in the hospital.
Supply Management
• The supply management module tracks the availability of medical stocks.
• It helps to calibrate the minimum quantity of supplies required without any hassle.
• It can also help plan to reorder supplies whenever stocks fall short.
• It provides details of the medicine available so that doctors can prescribe the ones in stock.
Financial Management
• Financial management is the most important part of any institute, and needs accurate and specific
monitoring.
• Financial Management module is used to manage all the financial affairs of the hospital.
• It calculates, stores, and presents the billing information to the patients.
• It records the expenses incurred by the hospital, revenue data, and other financial details of the
hospital.
• It saves time and energy as compared to analysing a colossal pile of record books.
Insurance Management
• Lot of people use health insurance facilities, either from the government and private sectors.
• Insurance Management Module of Health Management System records and stores the insurance
details of the patients.
• On requirement, it furnishes the policy number, insurance company, and other information
associated with it.
• It makes easy to fetch the details making insurance validation easier.
Laboratory Management
• Laboratory Management module shows the details of various lab-tests taken by patients.
• It sends the reports quickly to the required area of the indoor patients, for e.g., in wards or in
Operation Theatre.
• It furnishes reports when needed.
• It maintains all records for lab-tests collectively.
• It helps patients to avoid repeating the same lab-tests, thereby increasing efficiency and providing
quality health care.
Radiology Management
• Radiology Management module of the Hospital Management System records and stores all reports
from the radiology department of the hospital.
• It helps to maintain radio therapy and other radiological tests of the patient.
• It can be easily accessed by the doctors to understand the results.
Report Management
• Report Management module of Health Management System records and stores all the reports
generated by the hospital.
• In the case of financial reports, it analyses performance metrics for the business profitability.
• It also provides a comparison between performance reports of different years.
• It is used by the management to analyse performance of different parameters.
Support Management
• Support Management module of Hospital Management System records data of different complaints
and requests made by the patients and their attendants.
• It ensures proper resolution of requests and problems.
• It can be used to check the progress of the requests that are yet to closed.
Types of Health Care Software
• Pressure from regulatory authorities and general public is forcing digitization in the health care
sector .
• Government is pushing for digital systems to increase transparency in health care systems.
• Growing awareness in public raises demand for more efficient and accessible healthcare systems.
• Healthcare IT firms are trying to fulfil the needs of the clients through a variety of software service.
• Various healthcare software are discussed in the subsequent slides.
EHR (Electronic Health Records)
• EHR is used for storing patient information in a digital manner.
• EHR is used by hospitals to store the complete medical history of a patient.
• It provides a secure and easily accessible way of storing medical records compared to paper-based
records.
• EHR does not have the risk of loss of medical history or being illegible or destroyed over a long
period of time.
• It prevents duplication of medical records.
• It allows easy collaboration among health care providers as they all are able to access the same
records anywhere and anytime.
• Government health regulators in many countries are planning to make electronic health records
mandatory.
PMS (Practice Management Software)
• PMS are used for managing clinics and hospitals.
• Features available in PMS depend on the requirement of the clinic.
• PMS generally contain all components of HMS like appointment management, billing, electronic
health records.
• It is also available with integrated lab and pharmacy management features for associated labs or
pharmacies.
• Benefits of PMS are:
• Helps to streamline the workflow of a clinic
• Gets error-free documentation
• Manages appointments and billing
• Increases efficiency of the overall system
• Specialized systems are available for dental care, ophthalmology, and other specialty clinics.
HMS (Hospital Management Software)
• HMS is a fully integrated system capable of managing the entire hospital.
• It can manage appointments and electronic health records for both inpatient and outpatient
departments.
• It can manage medical staff’s schedules, surgeries, other procedures, and all other related aspects.
• It can also handle labs and pharmacies attached to the hospitals.
• HMS systems can also manage physical facilities of hospital.
• HMS is often linked to hospital websites for patients to book their appointments, get access to their
health records and treatment plans, and manage their prescriptions.
• HMS phone application allows easy access via phones and sends alerts for follow-up procedures.
• Due to the integrated nature of the HMS, all procedures, tests and medications are tracked that
allows easy comprehensive billing.
LIMS (Lab Information Management System)
• LIMS is used to manage the functions of a lab.
• It helps for sample collection, inventory management, accounting functions, and provisions for
machine interfacing with the lab equipment.
• Ideally, LIMS will provide full automation, and ensure error-free results, with alerts for abnormal
results.
• LIMS systems integrated with the HMS may have provision to add the test results to the patient
EHR.
• Stand-alone LIMS is also available for use by independent laboratories.
• LIMS helps lab technicians to achieve a smooth workflow and better quality control from sample
collection to test result delivery.
Billing Software
• Billing software has been adopted by hospitals and clinics ever since accounting went digital.
• Billing software helps to manage insurance claims and provides a smooth accounting of medical
bills.
• It helps to organize and access entire medical costs of all the patients (indoor or OPD) efficiently.
• Billing software are both available stand-alone as well as along with HMS/ PMS.
Use of HMS
• Manages and tracks financials (revenue, outflow, debt, receivables) better
• Secures data and reduces possibility of theft or misuse
• Eradicates and minimises errors due to automation of processes
• Makes diagnosis and treatment easier by providing easy and quick access to patient records and
test results to the healthcare providers
• Increases patient satisfaction by reducing time taken for process & procedure at every stage of
patient interaction
• Improves hospital Quality Ratings
• Paperless operation due to increased use of electronic records over physical files
• Increases clinical competency & ensures efficient operations in the hospital
HMS Workflow
Patient Registration
Scheduling an appointment in HMS

Insurance Plan
Sync with Insurance Service

Appointment Scheduling
Visit to the doctor Work with health records

Medical Test
Data transfer between lab and doctor

Diagnosis
Digital Healthcare Records

Treatment
Supply Chain, Accounting, Insurance

Automated Patient Database

Patient Monitoring
Summary
• Hospital Management Workflow involves lots of
important decisions that need to be made quickly
& efficiently.
• HMS is an integrated software that handles
different directions of hospital and clinic
workflows.
• HMS automates several daily operations &
manages smooth healthcare performance along
with administrative, medical, legal and financial
control.
• HMS stores all the kinds of records, provide
coordination and user communication, arrange
the supply chain, manage financial and human
resources, and market hospital services.
 Chapter – 11

Principles of Health Informatics

Arashgeet Kaur
Learning Objectives
• To describe the principles of health informatics
• To explain the way data, knowledge and information can be used for effective
healthcare
Chapter Outline
• Introduction to Health Informatics
• Area of Health Informatics
• Evolution of Health Informatics
• Need and Objectives of Health Informatics
• Dimensions of Health Informatics
• Benefits of Health Informatics
• Limitations & Challenges of Health Informatics
• Use of Data & Knowledge for Effective Healthcare
• Electronic Health Record
Introduction to Health Informatics
• Health Informatics is a discipline at the intersection of information science, computer science and
health care.
• Health Informatics aims to positively impact patient – physician relationship.
• Health Informatics helps effective collection, understanding, storage and safeguarding of the health
data.
• Health Informatics thus combines the power of data and computer science to healthcare.
• Health Informatics deals with resources, devices and methods to optimize the acquisition, storage,
retrieval, and use of information in health.
Definition of Health Informatics
Health Informatics science is defined as
"The integrative discipline that arises from the synergistic application of
computational, informational, cognitive, organizational, and other
sciences whose primary focus is the acquisition, storage, and use of
information in the health/biomedical domain."

• Four core elements of health informatics:

• The way healthcare professionals think about patients
• Making and evaluating diagnosis, as well as defining, selecting, and evolving treatments
• Creating, sharing and applying medical knowledge
• Organizing and running healthcare systems
Area of Health Informatics
Four major focus research areas in Health Informatics:
• Medical/ Bio Informatics – Physician and research based
• Nursing Informatics – Clinical and research based
• Public Health Informatics – Public health and bio surveillance based
• Applied Informatics – Policy, Process and Technological solutions
R&R of Health Informatics Professional
• Design & development of information systems that meet needs and requirements of users,
management and stakeholders.
• Development of systems allowing real-time communication/ diagnosis/ consultation using audio,
video & web-based technologies.
• Development of methods to gather, analyse and implement solutions using existing resources and
devices.
• Storing, organizing & analysing health records for easy retrieval and improving healthcare
outcomes.
• Developing protocols with medical facilities.
• Ensuring concerned medical staff can quickly and efficiently access patient’s medical records.
• Ensuring that accurate data can be shared efficiently and securely within the entire connected
ecosystem of multiple medical facilities.
• Ensuring that said systems are compliant to patient privacy and overall security requirements.
• Integration of multiple requirements into one user-friendly system.
 Evolution of Health Informatics
• ENIAC, first modern computer, was built. In India, The Ministry of Health &
1940s
Family Welfare (MoH&FW) came out
• Health informatics took off in the US, with its earliest use in with standards for Electronic Health
1950s dental projects in late 50s.
Record (EHR) for India in September
• Specialized training programs in Informatics in Europe. 2013, based on the recommendations
1960s • HMSS established to improve healthcare efficiency. made by the EMR Standards
• Increased use of computers for billing/ data processing.
Committee.
1970s • Medical Informatics Research Units est. in Poland / US.

• HMSS changed to HIMSS

1980s • AMIA formed in 1988.

• Data Protection Laws came into effect in US & Europe.

1990s

• Electronic Personal Health Records were devloped.

2000s • Telehealth & Telemedicine gained popularity.

• Medical Reimbursement Programs linked to EHRs in US

AMIA: American Medical Informatics Association
2010s • Implementation of EHRs by major organizations HMSS: Hospital Management Systems Society
HIMSS: Health Information & Management Systems Society
Need of Health Informatics
• To enable patients to have electronic access to their health records, diagnosis and treatment for
increased knowledge and awareness.
• To enable physicians provide better and quicker care due to availability of shared knowledge in
EHR.
• To increase coordination among specialists by communicating diagnosis to all health care
providers.
• To aid effective decision making for better overall outcome.
• To increase savings for patients by avoiding repeat procedures.
Objectives of Health Informatics
• To study the general principles of processing data, information and knowledge in medicine and
healthcare.
• To provide solutions for data and information storage, retrieval and acquisition, and knowledge
processing.
• To provide an efficient method for communicating, sharing and applying clinical evidence.
• To minimize resource use during organizational processes while securing maximum benefit.
• To save time while providing care.
• To develop tools and methods to achieve the above objectives.

The ultimate goal of health informatics is to be provide quality patient care.

Objectives of Health Informatics…Contd.
• Patient is the central focus of health
informatics.
• Patient is the centre of communication
within hospitals.
• Without patient, there would be no data.
• Data management focuses on diagnosis
and treatment of the patients.

Source: Health informatics, Michael Imhoff, Andrew Webb and Andreas Goldschmidt in Intensive Care Med
(2001) 27: 179-186, DOI 10.1007/s001340000747
Dimensions of Health Informatics
• Health Informatics is a multi-disciplinary field.
• It incorporates the skills and abilities from the three dimensions:
• ICT – Information and Communication Technology
• HIM – Health Information Management
• HIT – Health Information Technology

ICT

HIM HIT
ICT (Information & Communication Technology)
• Information Technology (IT) facilitates use of health information of patients & communication
technologies.
• IT helps to integrate data for identification, use and in management of information systems.
• ICT helps to meet business requirements by assisting in selection & utilization of proper
information technologies.
• ICT ensures coordinated systems with appropriate health informatics standards.
• ICT ensures to relate IT best practices (Quality management systems, testing, SLA, BCP and
Incident Management) throughout the system life cycle.
• ICT is fundamental to meeting the stakeholders’ need for information.
• ICT helps follow best practices and implement solutions to maintain data and system security.
HIM (Health Information Management)
• HIM promotes appropriate use of information and knowledge.
• HIM demonstrates the need to balance the use of medical information for improved care delivery
and patient privacy.
• HIM encourages use of appropriate technology, communication channel & organizational skills to
facilitate learning at multiple levels.
• HIM aims at clinical transformation through use of quality improvement and process engineering.
• HIM helps assess & mitigate risks to safety and privacy associated with health information.
• HIM contributes to evaluation of systems functionality to support best clinical care practices.
HIT (Health Information Technology)
• HIT involves applying basic clinical/ biomedical concepts, clinical care processes and technologies.
• HIT includes demonstration of knowledge regarding analysis, design, development &
implementation of health information systems.
• HIT includes demonstration of knowledge regarding the recording, communication and
incorporation of clinical data into system use.
• HIT facilitates use of electronic decision support tools to access evidence to support practice by
clinicians.
• HIT promotes use of Health Informatics in clinical settings.
Benefits of Health Informatics
• Provides easy access to data through EHRs, i.e. Digitized patient’s data containing personal and
medical information stored and backed-up securely, for both patients & healthcare providers.
• Provides special software with modern datasets and best practices for medical professionals.
• Helps improve patient care through quick assessment and recommendation tools available to
medical professionals.
• Helps in better decision making & minimize medical errors through use of Clinical Decision
Support Systems (CDSSs).
• Empowers patients by giving them access to their EHR, history and recommendation to take care
of their own health.
• Saves time by reducing time required for scheduling, storing & sharing data due to robust
electronic systems.
Limitations of Health Informatics
• Lack of computer literacy among masses.
• Lack of awareness of health security protocols.
• Infrastructural demand and initial high cost of investment for software implementation, data back-
up provision & training of manpower.
• Lack of uniformity among software, thereby hindering sharing of information among healthcare
facilities.
• Poor management practices.
• Lack of standard privacy laws.
• Concerns of data breach and cyber security.
• Difficult to customize alerts in systems due to standardization of decision support engines.
Use of Data & Knowledge for Healthcare
• Data is the fundamental element stored in information systems and is the basis for all constructs.
• From Data to Information to Knowledge:
• Data is facts and given attributes, such as age, gender, height, weight, temperature and other vitals.
• When meaning is attached to these facts, it becomes information.
• When information is received and interpreted, it becomes knowledge.
• In a healthcare facility, different systems and facilities use patient data.
• Sharing of data between departments is must to avoid duplication & maintain only one record of
the patient.
• In case of multiple accounts: data cleansing, record clean up and linking multiple data sets is
required to create one record per patient & to maintain data as a resource.
• Implementation of Health Informatics enables multiple entities to collaborate efficiently and
provide better patient care.
• Information and knowledge sharing is possible only when there is an efficient EHR for the patient.
EHR (Electronic Health Record)
Components of EHR are:
• Identification: Patient’s personal information (name, age, weight, height, other demographic data,
allergies), contact information, immunization schedule, medication, medical history.
• Affiliation Detail: Affiliation of a patient to a company (if any), its details and contacts, medical
insurance details, etc.
• Monitoring Details: Vitals such as temperature, sugar level, blood pressure level, heartbeat, etc.
• Diagnosis/ Reports/ Findings: Details on symptoms, what reports have been run, their results,
findings, and diagnosis, disease confirmation along with treatment and consultancy.
• Treatment Details: Treatment details, staff details, medication, diet, precautions, etc.
• Billing and Payments: Operative costs, mobility cost, different charges, etc.
Summary
• Health Informatics is a multi-disciplinary field.
• Health Informatics combines the power of data and computer science to healthcare.
• It is becoming popular as healthcare industry seeks secure and accurate ways to manage the ever-
growing volumes of health data and seek coordination to save time and cost.
• The goal of Health Informatics is to improve patient care as well as develop tools to handle large
amount of patient data.
• Health Informatics covers three dimensions of ICT, HIM and HIT.
• While Health Informatics has several benefits for all the stakeholders, it still faces challenges such
as security, lack of infrastructure and skilled technicians among others.
 Chapter – 12

Information Systems in Healthcare

Arashgeet Kaur
Learning Objectives
• To describe the concept of Information Systems in Healthcare
• To demonstrate the use of HIS (Health Information System) in Hospital setting
Chapter Outline
• Introduction to Information System in Healthcare
• Role & Architecture of Information System in modern healthcare environment
• Hospital Information System (HIS)
• Need of HIS
• Features of HIS
• Benefits of HIS
• Challenges to adoption of HIS
• Clinical Information System (CIS)
Introduction
• Healthcare facilities are making significant investments in Information and Communication
Technologies (ICT).
• ICT helps reduce errors, increase patient safety, and thus have a positive impact on patient health.
• Healthcare providers need to share information for an integrated and collaborative treatment,
facilitated by Information Systems.
• Sharing data through Information Systems helps eliminate repetition of medical tests or ignoring
prior findings.
• Lack of Information Systems can lead to loss of lifesaving information during an emergency and
pose threat to patients in critical conditions.
Health Information Systems
 Introduction to Information Systems in Healthcare
• The information systems and technologies (EHR, CDSS, e-prescription, e-referral, etc.) allow
information sharing among healthcare facilities.
• They help improve the patient care quality, patient safety and efficiency of the healthcare system.
• Health Management Information System can be defined as “a management and information system
primarily developed to improve healthcare facilities and organizations’ planning, management and
decision-making.”
• Information system uses data to assist in healthcare growth, management, planning and decision
making.
• It provides reliable, accurate, up-to-date and usable real-time health information to healthcare
providers and management.

EHR - Electronic Health Record

CDSS - Clinical Decision Support System
Role & Architecture of Information System

Conceptual Architecture of Health Information System

 Role & Architecture of Information System
Different areas interact with each other through centralized services and a comprehensive integration
layer (labelled as “middleware”).
• Administrative and Management Area, to support processes like general administration,
procurement & storage of assets, logistics planning, management control, ERP and HR Planning.
• Front-Office Area, to deal with patient reception.
• COBC: It manages outpatients for diagnostic service booking, communication of work list to clinical
services, collection and verification of consents, and billing for the services.
• ADT System: It supports management of waiting lists, pre-admission, registration of patients, post-
admission, and ADT within the hospital.
• Clinical Area, involves critical patient data and supports core processes in the hospital.
• RIS: Manages acquisition of radiological images, their analysis and relative reporting.
• LIS: Manages exam request from clinical units, supports sophisticated controls with validation of results.
• Applications of Operating Room: Manages logging of events and data relevant to surgery; production of
clinical surgery documentation.

COBC - Centralized Outpatient Booking Centre; ERP - Enterprise Resource Planning; RIS - Radiology Information Systems
ADT- Acceptance-Discharge-Transfer; HR - Human Resource; LIS - Laboratory Information Systems
 Role & Architecture of Information System
• Shared Services, that includes the following services:
• Central patients and encoding database: Manages & makes patient identifiers (MPI) available for other
components of HIS.
• Prescriptions Generation: Manages preparation, digital signature and issuing of all prescriptions.
• Order Entry: Manages ward requests for internal exams and second opinion consultations.
• Medical Reports Generation: Manages generation and issuing of medical reports for all hospital services.
• Clinical Repository: Manages a repository of medical reports, structured data, patient events, exam
requests and therapy prescriptions among other data. It is used by all other systems to retrieve official
documents and data on past episodes.

MPI – Master Patient Index

HIS – Health Information Systems
Examples of Health Information Systems
• EMR (Electronic Medical Record) & EHR (Electronic Health Record): EMR and EHR contain
patient’s medical history, test results, and treatments.
• Practice Management Software: To manage daily operations (scheduling and billing) and
automate administrative tasks.
• Master Patient Index (MPI): To connect separate patient records across different databases and
healthcare organizations.
• Patient Portals: Allows patients to access their personal health data (appointment information,
medication, test results, etc.) and actively communicate with healthcare providers.
• Remote Patient Monitoring (RPM): Tele-health allows medical sensors to send patient data to
healthcare providers and identifying medical events that require intervention.
• Clinical Decision Support (CDS): Helps to make clinical decisions, prepare diagnoses or predict
medical events.
Data Management Capability in
Computerized Information System
Benefits of Information System in Healthcare
• Reduce healthcare cost and manage population through data analytics.
• Efficient exchange of data using digital networks.
• Provides collaborative care to patients through Health Information Exchanges (HIEs) by allowing
access to EHRs.
• Cost savings in sharing data because of use of health information exchanges.
• Improves patient care through data analytics.
• Population health management by aggregating patient data, analysing it and identifying trends in
populations.
Hospital Information System
(HIS)
Introduction to HIS
• Hospital Information System (HIS) simplifies the hospital workflow through digitization.
• HIS is an integrated information system to manage hospital's operations (medical, administrative,
financial, and legal issues) and the corresponding processing of services.
• HIS is focused primarily on the operations management of the hospital.
• Two modules of HIS are:
• Clinical Module: Patient centric module that deals with patient appointments, registration, billing,
medicines as well as doctors and the surgeries and treatments.
• Administration Module: Handles the back office information such as accounts, stores, asset
management, human resource management, billing and insurance and so on.
• Clinical Module eases out tasks for doctors and enables them to spend more time with patients.
• Administration Module helps to keep track of the revenue, outstanding payments, purchases and
stocks for hospital management.
HIS Module
(An example)
Avanttec, a healthcare IT
Organization, came out with a HIS
that suits any type and size of
hospitals.
Need of HIS
• The Hospital Information system should be efficient, cost-effective and reliable.
• The importance of HIS:
• Higher revenue management
• Enhanced clinical decision making
• Enhanced data security
• Elimination of errors
• Increased capability of system to retrieve required data
• Enhanced efficiency and patient care
• Higher reputation of healthcare facility through good quality ratings
 Features in HIS
• Primary use of the Hospital Information Management System is healthcare management.
• Features in an advanced and efficient HIS:
• Appointment scheduling for patients as per specialists’ availability
• IP, OP and OT integration for appointment management, reports, asset management, room management,
and workforce planning.
• Billing (insurance discounts, service price, any other additional charges, etc.) for patient registration,
doctor fees, tests conducted, etc.
• Insurance settlement via insurance auto-detection, templates and tax calculation as per the country’s
guidelines.
• Laboratory Integration for sample collection, machine interfacing, recording information about the tests
being performed, and generating custom reports and analytics.
• Pharmacy Integration for stock management, automatic expiry alerts, barcodes, inbuilt tax calculations,
etc. as well to handle prescriptions and generate reports.
• Speciality Based Modules compatible with imaging technologies to deliver results.
• Integrated interface and distinct user roles to provide people with privacy and data security.

IP: In-Patient; OP: Out-Patient; OT: Operation Theatre

Benefits of HIS
• Reduces errors by eliminating manual handwriting in conventional reports.
• Easy to retrieve information as and when required.
• Reduces duplication of information.
• Better planning for work structure, processes and flows of the business environment.
• Efficient management of inventory within the OT, OPD, pharmacies, laboratories, etc.
• Optimizing resource management and enhancing information integrity.
• Efficient and accurate administration of finance, distribution of medical aid, engineering, etc.
• Better revenue management.
• Greater visibility for healthcare providers and management to perform statistical analysis for better
understanding of hospital needs.
Challenges to adoption of HIS
• To maintain data privacy and security & be compliant to local government laws.
• To ensure data is shared only among authorized users, and doctor-patient confidentiality is not
violated.
• High initial investment on digital infrastructure, technical sophistication and highly skilled human
resources.
• Inability to see benefit of adoption of HIS by management.
• Lack of readiness by medical professionals to move to a digital system due to professional or
personal barriers.
• Poor System Design & Lack of customization in rigid software system.
Introduction to CIS
• The Clinical Information System facilitates direct patient care, i.e. activities where care providers
but also includes dieticians, therapists, clinical psychologists, clinical pharmacists, clinical
microbiologists, endoscopists, optometrists, audiologists and many others.
• The CIS contains application modules that enable the following:
• Planning of care
• Provision of Clinical Decision Support
• Clinical Data Documentation
• Quality Control
• Data Storage
• Data Retrieval and Display
CIS as part of Hospital Information System
• CIS enables electronic prescribing and administration record for drugs and fluids, thus enhancing
clinical safety and quality.
• CIS ensure legibility, attribution and completeness of administration and prescribing.
Summary
• An integrated and collaborative treatment by health facilities requires the sharing of information
between care providers through information systems.
• EHRs (Electronic Health Records), CDSS (Clinical Decision Support System), Electronic
prescription, electronic referral, etc. allow information sharing among the facilities.
• Health Management Information System can be defined as a management and information system
primarily developed to improve healthcare facilities and organizations’ planning, management and
decision-making.
• HIS is a comprehensive, integrated information system designed to manage all the aspects of a
hospital's operation the corresponding processing of services.
• HIS has majorly two modules: Clinical and Administrative Module.
• HIS helps increase revenue and optimize resource management that eventually helps better
planning and aids hospital growth.
 Chapter – 13

Shared Care and

Electronic Health Records
Arashgeet Kaur
Learning Objectives
• To explain the use of Electronic Health Records in nursing practice
• To describe the latest trends in electronic health records standards and
interoperability
Chapter Outline
• Electronic Health Record (EHR)
• Role of EHR
• Characteristics of a good EHR
• Benefits of EHR
• Applications of EHR
• Challenges of capturing rich patient history in a computable form
• Latest global development & standards in EHR
• Future of EHR technologies
Introduction to Electronic Health Record
• Electronic Health Record (EHR) is electronic version of patient’s health record.
• EHRs can make patient information available instantly and securely to the concerned personnel.
• EHRs reduce the incidence of medical errors by improving efficiency, accuracy and clarity of
medical records.

EHR, as defined by HIMSS in National Institute of Health Report (2006), is

“… a longitudinal electronic record of patient health information generated by one
or more encounters in any care delivery system. Included in this information are
patient demographics, progress notes, problems, medications, vital signs, past
medical history, immunizations, laboratory data, and radiology reports. The EHR
automates and streamlines the clinician’s workflow. The EHR has the ability to
generate a complete record of a clinical patient encounter, as well as supporting
other care-related activities directly or indirectly via interface, including evidence-
based decision support, quality management, and outcome’s reporting.”
Features of EHR
• EHR is a digital record that provides comprehensive health information about the patients.
• It contains information created and managed by authorized providers in a digital format.
• EHRs contain real time information.
• EHRs can help share information across health providers in different health care organizations
(hospitals, specialists, laboratories, pharmacies, workplace clinics, emergency facilities, medical
imaging facilities).
• EHRs help improve patient care by making the health information readily available.
• EHRs reduce delay in treatments and reduce duplication of tests.
Contents of EHR
An EHR contains following data, including but not limited to:
• Patient Demographics
• Immunization Dates
• Allergies
• Medical histories
• Administrative and Billing data
• Vital signs
• Radiology images
• Lab and Test Results
• Diagnoses
• Medications and pharmacy prescriptions
• Progress notes
Need of EHR
EHR shall be the central data base about the patient to drive documentation, clinical decision support,
quality and billing. EHR is needed for:
• For patient documentation, including contains patient history, pharmacy prescription, laboratory
results, medical imaging results, etc. as well as details about doctor-patient interaction.
• To enable healthcare providers to provide more efficient & better quality patient care.
• For convenient portability of health records to avoid duplication of tests and delayed diagnosis, and
making it easier for patient to seek multiple expert opinions
• To track utilization of resources by patients and smoother financial reporting.
• To allocate budget and resources more efficiently in the hospital for patients.
• To increase accuracy and efficiency in billing for patients.
• To expedite medical insurance claims and limit the chances for inaccurate claims and frauds.
• To provide access to patient’s medical data anywhere and anytime while maintaining patient
confidentiality using a robust security system.
Role of EHR
• EHR represents responsibilities & intentions within shared care process to support effective clinical workflow.

• EHR supports patient involvement.

• EHR protects the personal privacy and maintains confidentiality of the patient data.
• EHR ensures accountability of health professionals and reduces room for negligence.
• EHR supports patient healthcare & be used to anticipate future health problems and actions for preventive care.
• EHR supports selective retrieval of information and encourages supports collaborative care.

• EHR supports communication between departments in a healthcare facility or among different facilities.
• EHR supports continuous professional assessment and enhances the efficiency of the healthcare professionals.

• EHR facilitates management tasks and reduces routine reporting.

• EHR provides evidence for development and evaluation of national health programs.
• EHR can support developing of policies by government for public welfare.

• EHR supports medical enquiry, learning and clinical research.

Characteristics of a Good EHR
• A good EHR has precise, easy to find, accurate and complete information on health-related data of
the patient.
• An EHR should offer a flexible framework for recording the patient-doctor consultation and
accommodate their individuality.
• An EHR should have structured, systematized and prescriptive information stored properly to
ensure good data quality.
• An EHR shall contain decisions and the rationale behind it, and can be shared amongst clinicians.
• An EHR must enable information grouping under headings and subheadings in a meaningful way.
• An EHR should be both medically and legally acceptable.
• EHR should also be implemented with formal security and be accessible only to the relevant
stakeholders
• Patients and their families must be valid authors to record entries and contribute their own
impression of health needs and status in an EHR.
Benefits of EHR
• EHR provides complete, accurate and real-time information about patients.
• EHR helps provide efficient and coordinated care by enabling quick access to patient records.
• EHRs enable sharing electronic information with patients and clinicians securely.
• EHR reduces medical errors and thus helps to improve the performance of health professionals.
• EHRs help reduce administrative and operation cost.
• EHRs also contain prescription that helps eliminate medical drug errors.
• EHR improves patient-doctor interaction, thereby increasing healthcare convenience.
• EHR helps bring down redundancy and costs, through decreased duplication of testing and
paperwork.
• EHR helps to allocate resources and budgeting in a hospital.
• EHR encourages healthy lifestyle by increasing physical activity, avoidance of behavioural risks
and wider use of preventive care.
Applications of EHR
Application Description

Administrative Patient registration that records patient demographics (name, age, sex, address, contact,
Applications insurance information, patient’s complaint); Assigning unique patient ID.

Laboratory Interfacing with Lab for exchange of patient data, lab orders, schedules, testing results and
Systems other administrative functions.

Radiology Interfacing with radiology information system for exchange of patient data and digital
Systems radiology images.

Clinical Documenting patient information ranging from reports, assessment, vital signs, transcription
Documentation documents, etc.

Pharmacy Has prescription and the number of doses to be taken at the right time; Automation in filling
Systems prescriptions; Reduction in drug errors; Ensuring stock availability of right medicines timely.
Challenges of Capturing History in EHR
• High implementation cost
• Low acceptance among healthcare providers/ nurses to move from paper based system to EHR
• Manpower training to build efficient EHR and overcome resistance to adopting a new system
• Awareness among patients
• Increased documentation time
• System limitation with respect to hardware and software & other facilities
• Maintaining data security & integrity
• Scare of medical identity theft
• Inability to realize benefits by management
• Lack of push in implementing EHR by the government
Latest Global Standards for EHR
• Efficient access to EHR is important for:
• Support of continuity of care
• Reduction of avoidable mistakes
• Provision of tools and methods to support evidence-based medicine.

• EHRs Then and Now:

• Initially, EHRs were developed and used at academic inpatient and outpatient medical facilities.
• Most EHRs today are still a hybrid collection of computerized and paper data.
• Need of standardization is arising as third-party applications are being increasingly used within EHRs.
• Need of increased collaboration among healthcare providers and IT personnel to bring about required
changes in EHRs.
 EHR Standards in India
• The Ministry of Health and Family Welfare (MoH&FW) notified the EHR standards for India in
2013 & later modified in 2016.
• It introduced a uniform standard-based system for creation and maintenance of EHRs.
• Indian government acknowledged the need to develop standards applicable to EHR and constituted
an experts committee to recommend the standards.

S. No. Type Standard Name Intended Purpose

ISO/TS 22220:2011 Health Informatics – Identification of
1 Basic identity details of patient
Identification & Subjects of Health Care
Demographics MDDS – Demographic (Person Identification and Land Complete demographic for inter-operability
2
Region Codification) version 1.1 with e-governance systems
3 UIDAI Aadhaar Preferable identifier where available
4 Local Identifier Given within clinic/ lab
Patient Identifiers
Used in conjunction with local, in absence of
5 Government issued Photo Identity Card Number
Aadhaar
Architecture ISO 18308:2011 Health Informatics – Requirements for an
6 System architectural requirements
Requirements Electronic Health Record Architecture
 EHR Standards in India… Contd.
S. No. Type Standard Name Intended Purpose
Functional ISO/HL7 10781:2015 Health Informatics – HL7 Electronic Health
7 System functional requirements
requirements Records- System Functional Model Release 2 (EHR FM)
ISO 13940 Health Informatics – System of Concepts to support Concepts for care, activities, processes,
8
Continuity of Care etc.
Reference Model
Information model architecture and
9 and Composition ISO 13606 Health Informatics – EHR Communication
communication
10 openEHR Foundation Models Release 1.0.2 Structural definition and composition
11 Terminology SNOMED Clinical Terms (SNOMED CT) Primary terminology
12 LONIC (Logical Observation Identifiers Names and Codes) Test, measurement, observations
Coding System WHO Family of International Classifications (WHO-FIC),
13 Classification and reporting
including ICD, ICF, ICHI, ICD-O
DICOM (Digital Imaging and Communications in Medicine)
14 Imaging Image, waveform, audio/video
PS3.0-2015
JPEG Lossless with size & resolution not less than 1024px X
15 Image capture format
768px at 300 dpi
Scanned or
16 ISO/IEC 14496 – Coding of Audio-visual Objects Audio/ Video capture format
Captured Records
ISO 19005-2 Document Management – Electronic Document File
17 Scanned Documents format
Format for Long-Term Preservation – Part 2: Use of ISO 32000-1
 EHR Standards in India… Contd.
S. No. Type Standard Name Intended Purpose
ANSI/HL7 V2.8.2-2015 HL7 Standard Version 2.8.2 - An
18 Application Protocol for Electronic Data Exchange in Healthcare Event/ Message exchange
Environments

19 ASTM/HL7 CCD Release 1 (basis standard ISO/HL7 27932:2009) Summary Records exchange
Data Exchange
ISO 13606-5:2010 Health informatics – Electronic Health Record
20 EHR Archetypes exchange
Communication - Part 5: Interface Specification

21 DICOM PS3.0-2015 (using DIMSE services & Part-10 media/files) Imaging/ Waveform exchange

Bureau of Indian Standards and its MHD-17

22
Other Relevant Committee Standards Development
23 Standards ISO TC 215 set of standards Organization (SDOs)
24 IEEE/NEMA/CE standards for physical systems and interfaces
Discharge/ Treatment
25 Medical Council of India (MCI) under regulation 3.1 of Ethics Composition as described
Summary
Pharmacy Practice Regulations, 2015 Notification No. 14-148/ 2012-
26 e-prescription Composition as described
PCI as specified by Pharmacy Council of India
 EHR Standards in India… Contd.
S. No. Type Standard Name Intended Purpose
Personal Healthcare and IEEE 11073 health informatics standards and related ISO
27 Device interfacing
medical device interface standards for medical devices
ISO/TS 14441:2013 Health Informatics – Security &
28 Data Privacy and Security Privacy Requirements of EHR Systems for Use in Basis security and privacy requirements
Conformity Assessment
Information Security ISO/DIS 27799 Health informatics – Information Overall information security
29
Management Security Management in Health using ISO/IEC 27002 management
Privilege Management and ISO 22600:2014 Health informatics – Privilege
30 Access control
Access Control Management and Access Control (Part 1 through 3)
ISO 27789:2013 Health informatics - Audit trails for
31 Audit Trail and Logs Audit Trail
EHR
Secure Hash Algorithm (SHA) used must be SHA-256 or
32 Data Integrity Data Hashing
higher
33 Minimum 256-bits key length Encryption Key
Data encryption
34 HTTPS, SSL v3.0, and TLS v1.2 Encrypted Connection
ISO 17090 Health informatics - Public Key
35 Digital Certificate Digital certificates use and management
Infrastructure
EHR Standards in India… Contd.
S. No. Standard Description
1 ISO 12967:2009 Health Informatics - Service Architecture
2 ISO 13972:2015 Health Informatics - Detailed Clinical Models, Characteristics and Processes
3 ISO 20301:2014 Health Informatics - Health Cards - General Characteristics
4 ISO 21090:2011 Health Informatics - Harmonized Data Types for Information Interchange

Data elements and Interchange Formats - Information Interchange -

5 ISO 8601:2004
Representation of Dates and Times

6 ISO 13119:2012 Health Informatics - Clinical Knowledge Resources - Metadata

Health Informatics – Guidelines on Data Protection to Facilitate Trans- Border

7 ISO 22857:2013
Flows of Personal Health Data

8 ISO 21549-1:2013 Health Informatics — Patient Healthcard Data — Part 1: General Structure
9 ISO TS 14265:2011 Classification of Purposes for Processing Personal Health Information
10 ISO TS 27527:2010 Health Informatics – Provider Identification
 EHR Standards in India - 2016
• GoI planned to introduce a uniform system for maintenance of EMR by healthcare providers in
India.
• An expert committee was set up to monitor the development of standards for EMR and EHR, and
standards for adoption and implementation in India.
• After due consideration, ‘Electronic Health Record Standards for India’ were finalized and
approved by the MoHFW, Government of India.
• MOHFW has also established an Integrated Health Information Platform (IHIP), with objectives
outlined as below:
• Enabling the creation of standards compliant EHRs of the citizens pan-India.
• Ensuring that the EHRs are standards-complaint as approved.
• Integration and interoperability of the EHRs through a comprehensive Health Information Exchange
(HIE) as part of centralized accessible platform.
• IHIP envisions to facilitate improvement in the reforms of treatment and care of the public health.
• IHIP envisions to enable better diagnosis of diseases, reducing patient re-visits and prevention of medical
errors, while ensuring affordability & optimal information exchange.
GoI – Government of India
MoHFW - Ministry of Health and Family Welfare
 Future of EHR Technologies
EHR technologies will rapidly continue to evolve as the adoption increases among countries at
difference pace.
• Wide scope to increase interoperability of EHRs between different health facilities within a country
and beyond.
• Development of a standard policy to govern data security of EHR while granting access to relevant
stakeholders anywhere in the world.
• Improvement in healthcare and lower costs using data-mined health data.
• Prediction of potential patients who could develop chronic diseases.
• Adoption of technologies (Bar-coding, RFID) to gain more efficiency & track supplies, medical
equipment and patients.
• Speech recognition technology can become a major tool for healthcare physicians and nurses to
document clinical encounters.

RFID – Radio Frequency Identification

Summary
• EHR is an electronic version of patient’s health record that was historically created, used and
stored on a paper chart.
• EHRs are real-time.
• EHRs contain patient’s demographics data, results, diagnoses, medication, etc.
• EHRs have clinical and administrative needs, such as patient documentation, confidentiality,
billing, etc.
• EHR supports patient involvement, communication, patient healthcare, population healthcare, etc.
• EHR helps provide efficient and coordinated care with reduced administrative and operation cost.
• EHRs, however, face system limitations, fear of data breach, and the inability to realize benefits in
case meaningful government policies lack.
 Chapter – 14

Patient Safety & Clinical Risk

Arashgeet Kaur
Learning Objectives
• Relationship between patient safety and informatics
• Function and application of the risk management process
• Describe the advantages and limitations of health informatics in maintaining patient
safety & risk management
Chapter Outline
• Patient Safety
• Function and Application of the Risk Management Process
• Relationship between Patient & Informatics (HIT, Healthcare Information
Technology)
Introduction to Patient Safety
• The rising complexity in healthcare systems has led to increase in patient harm in healthcare
facilities.
• Patient safety has become an emerging health care discipline.
• Patient safety aims to reduce and prevent risks, errors and harm that occurs to patients during
provision of health care.
• Quality health services should be effective, safe and people-centred, and are delivered when patient
safety is fundamental.
• Clear policies, leadership capacity, skilled health care professionals and effective involvement of
patients is needed to ensure implementation of patient safety strategies.

Patient safety is defined as

“The avoidance, prevention, and amelioration of adverse outcomes or
injuries stemming from the processes of health care.”
Causes of Patient Harm
• Medical error is the failure of planed action to be completed as intended.
• Medical errors can occur anywhere in healthcare system: from hospitals to nursing homes, to
pharmacies.
• Four types of medical errors:

Error Description

Near-Miss An incidence about to happen, but did not occur by chance

Sentinel Events An unexpected occurrence involving death or serious physical or psychological injury

Medication Errors Preventable event that may cause or lead to inappropriate medication use

An incident in which harm resulted to a person receiving health care. This could include
Adverse Events
infections, physical harm, etc.
Patient Safety Situations
Several medical practices & risks associated with health care are emerging as major challenges for
patient safety.
• Medical complexity (e.g. complicated technologies, • Medication Errors
prolonged hospital stay) • Prescribing errors (Incorrect selection of drugs)
• Health-care associated infections • Omission errors (Missing a scheduled drug dose)
• Unsafe surgical care procedures • Improper dosing errors (Incorrect quantity of drug
prescribed)
• Unsafe injection practices
• Wrong dose errors (Incorrect quantity of drug
• Diagnostic errors administered)
• Unsafe transfusion practices • Improper administration technique errors
• Radiation errors • Wrong drug preparation errors
• Sepsis • Fragmented care errors (Due to lack of
• Venous thromboembolism (blood clots) communication between prescribing physician and
• Human Factors other professionals)
• Variations in healthcare provider training & • System Failures
experience • Unsafe communication
• Fatigue or depression in healthcare provider • Disconnected reporting systems in a health care
• Failure to acknowledge seriousness of medical facility
errors • Monitoring environment and design factors
• Anxiety or stress • Infrastructure failure
Typical case of Patient Harm due to Human Error
Mix-up in medication due to similar packaging
• How:
• Pharmacy dispensing the incorrect medication
• Nurse administering the same to the patient
• Underlying factors:
• Incorrect standards and procedure for storage of medicines
• Lack of verification before administering medicine
• Lack of involvement of patient
• Consequences:
• Risk to patient safety
• Loss of trust in health care facilities
• Monetary cost
• Reduced patient satisfaction
• Degraded morale among health care professionals.
• To avoid the error: Safe guarding process at different levels.
Causes of Medication Errors
• Lack of knowledge among nurses on drug prescription, its various generic & brand names, side
effects, or on how drugs work can make errors.
• Incomplete patient information regarding patient’s allergies towards certain medication, or other
medication already being taken by the patient.
• Environmental factors such as lack of proper lighting, heat or cold, etc. can lead to distractions.
• Distraction among nurses due to being overworked, that can lead to exhaustion, reduced efficiency
or forgetting critical patient information (such as allergies, etc.)
• Systematic Problems such as mislabelling medication, placing similar-named medicines in
proximity, etc.
Risk Management Process
Clinical Risk
• A clinical risk or healthcare risk is the chance of an adverse outcome resulting from clinical
investigation, treatment or patient care.
• Clinical risk management is a whole systems approach to identify, assess, evaluate, minimize and
communicate risk associated with clinical activities in order to maximize safety for all.
• All stakeholders in a health care facility are responsible to take a corrective action upon observing
any unsafe behaviour.
• Safety culture needs to be established in healthcare facilities where high level of importance is
placed on safety beliefs, values and attitude.
Risk Management Process
Healthcare Risk Management comprises the clinical and administrative
systems and processes employed to uncover, monitor, assess, mitigate,
and prevent risks in healthcare institutions.

• It is important to focus on all aspects of clinical care to reduce risk to patients.

• Many hospitals have developed systems to report patient falls, medication errors, retained swabs
and misidentification of patients.
• Risk management is important to safeguard:
• Patient safety
• Assets of the healthcare facility
• Accreditation and brand value of the healthcare facility
• Keeps the trust of community alive
Clinical Risk Management & Patient Safety
• Clinical risk management is specifically concerned with improving the quality and safety of health
care services.
• Clinical risk management in relevant to patient safety.
• It identifies the circumstances and opportunities that put patients at risk.
• It acts to prevent or reduce the risks.
• Four steps to manage clinical risks are:
1. Identify the risk
2. Assess the frequency and severity of the risk
3. Reduce or eliminate the risk
4. Review the effectiveness of assessment and action plan
• All health care providers must understand the relevance of risk
management strategies at the workplace for effective risk
management.

ASHRM ERM Framework

Enterprise Risk Management (ERM)
• ERM is a more holistic approach being adopted to expand the
role of risk management across the organization, hospitals
and other healthcare facilities.
• ERM includes traditional aspects of risk management
(patient safety, medical liability) & expands with other
aspects across the organization.

According to the American Society for Healthcare Risk

Management (ASHRM):
“Enterprise Risk Management (ERM) in healthcare
promotes a comprehensive framework for making
risk management decisions which maximize value
8 domains of ERM
protection and creation by managing risk and
(Source: ASHRM Enterprise Risk
uncertainty and their connections to total value.” Management: A framework for success, NEJM
Catalyst, Massachusetts Medical Society)
Components of Risk Management in Healthcare
• Identifying Risk
• Through the use of data.
• By institutional and industry knowledge.
• By engaging the stakeholders (patients, employees, administrators, and payers).
• Important to uncover the threats and manage uncertainty due to continually emerging risks.
• Quantify & Prioritize Risk
• Prioritization based on their likelihood and impact of occurrence.
• Resource allocation & tasks alignment to prevent risks.
• Development of Risk matrices & heat maps to visualize risks & promote collaborative decision-making.
• Investigate & Report ‘Sentinel’ Events
• Reporting of any unanticipated events causing death or serious injury.
• Quick and thorough investigation to address immediate patient safety issues and reduce future risk
• Having an established plan promotes calm and measured response, and transparency by staff.
• Ensuring the implementation and evaluation of corrective actions.
Components of Risk Management in Healthcare…Contd.
• Perform Compliance
• Reporting of events as required by the government laws.
• Documenting/Coding/ Reporting of incidents such as wrong-site or patient surgery, workplace injuries,
medication errors, etc.
• Capture & Learn from ‘Near Misses’
• Treat ‘near miss’ to identify and prevent risk.
• Encouraging safe environment & culture to report ‘Near Miss’ events to institute best practices.
• Uncover Latent Failures
• Through analysis and critical examination to uncover latent failures.
• For e.g., Overlooking of time/ quantity of medication by the nurse because of inability to read patient’s
chart due to poor lighting.
Components of Risk Management in Healthcare…Contd.
• Incident Investigation
• Analyse accidents to understand latent failures and causes.
• Analyse accidents to understand relationships among risks.
• For e.g., Failure Mode and Effects Analysis (FMEA), or Root Cause Analysis to uncover the causes and
effects of medical mistakes.
• Investment in a Robust Risk Management Information System (RMIS)
• RMIS can provide a single platform for reporting and managing risk.
• RMIS can help document incidents, track risk, report trends, benchmark data points, and make industry
comparisons.
• RMIS can help generate reports for losses, incidents, open claims, and lost work time for injured
employees.
• Beneficial for overall cost reduction and automation of routine tasks.
• Find the Right Balance of Risk Financing, Transfer and Retention:
• Important for organization to efficiently and effectively fund loss that results from risk.
• Risk transfer through insurance policies
• Risk retention such as self-insurance and captive insurance.
Healthcare Risk Management Plan
• Healthcare facilities must have a Risk Management Plan in place.
• A Risk Management Plan is a guiding document for an organization to strategically identify,
manage and mitigate risk.
• It is developed & evaluated by healthcare facility’s leadership, along with involvement of all
department heads.
• It should communicate the purpose, scope, and objectives of the organization’s risk management
protocol.
• It should define the roles and responsibilities of the risk manager and other staff involved in risk
mitigation.
• It may vary from one facility to another depending upon current systems and historical data.
Create a Healthcare Risk Management Plan
• Fundamental components of a Risk Management Plan:
• Purpose and benefits of the plan
• Well-articulated Goals (e.g., to reduce liability claims, sentinel events, near misses, errors, and overall
cost of risk)
• Metrics - Reporting on quantifiable and actionable data
• New Employee Education/ In-Service employee Training
• Annual review and competency validation of healthcare providers
• Documentation Procedure for registering complaints
• Staff responsibilities upon complaint registration & Response time
• Plan on how to communicate risk
• Reporting Protocols for documenting, classifying, & tracking possible risks and adverse events.
• Response & Mitigation
• Contingency Plans (For times such as malfunctioning EHR systems, security breaches, and cyber-
attacks)
• Healthcare Risk Management Plan must be frequently reviewed, updated and improved.
Healthcare Information Technology (HIT)
Healthcare Information Technology (HIT) is defined as
“The application of information processing involving both computer
hardware and software that deals with storage, retrieval, sharing and use
of health care information, data, and knowledge for communication and
decision making.”

• HIT includes various technologies from simple charts to advanced decision support integrated with
medical technology.
• HIT is an important tool to improve the healthcare safety as well as quality.
HIT & Patient Safety
• HIT improves patient safety by:
• Reducing medication errors
• Reducing adverse drug reactions
• Improving compliance to practice guidelines

• HIT presents several opportunities for improving and transforming healthcare:

• Reducing medical errors
• Improving clinical outcomes
• Facilitating care coordination
• Improving practice efficiencies
• Tracking data
Components of HIT to enhance Patient Safety
• Clinical Decision Support (CDS)
• Computerized Physician Order Entry (CPOE) and e-prescribing
• Electronic sign-out and hand-off tools
• Patient Electronic Portals
• Telemedicine and Synchronous Telemedicine
• Remote Patient Monitoring
• Electronic Incident Reporting
• Electronic Health Records
Summary
• Patient safety is an emerging healthcare discipline, as increasing complexity in healthcare systems
leads to increase in patient harm.
• Patient harm can occur due to medical errors, anywhere from hospitals to pharmacies, because of
human or system shortcomings.
• A clinical risk is the chance of adverse outcome resulting from clinical investigation, treatment or
patient care.
• Healthcare risk management comprises of the systems to uncover and prevent risks, and safeguard
patient safety.
• Healthcare Risk Management has developed into a more holistic approach under Enterprise Risk
Management that covers broader aspects under eight separate risk domains.
• Healthcare Information Technology includes various technologies from simple charts to advanced
decision support integrated with medical technology, to improve the healthcare safety as well as
quality.
 Chapter – 15

Clinical Knowledge and

Decision Making
Arashgeet Kaur
Learning Objectives
• Explain the importance of knowledge management
• To describe the standardized language used in health informatics
Chapter Outline
• Role of Knowledge Management in Improving Decision-Making in Clinical and
Policy Context
• Systematized Nomenclature of Medicine (SNOMED)
• ICD-10-CM
• SNOMED to ICD-10-CM Map
• Standard Nursing Terminologies
Introduction
• For India, a country that has a large population, vast knowledge and expertise are required to treat
every patient’s unique symptoms.
• Clinical knowledge as well as knowledge about process and procedures, treatment information,
patient information, etc. are required to treat patients effectively.
• Healthcare industry is knowledge driven industry.
• A knowledge management system is must for sufficient & efficient flow of information between
the healthcare providers, staff and the patient.
Knowledge Management in
Healthcare Industry
Knowledge Management in Healthcare Industry
• Medical field is based on scientific knowledge.
• ‘Knowledge’ is defined as facts that can be empirically verified by bio-medical methods.

Knowledge management is the practice of harnessing and building upon

a core set of knowledge to enable an individual or a group of individuals
to do their best work.

• Healthcare knowledge management is important for healthcare professionals to find updated

health, patient, and processes information takes time.
• The patient’s life depends on this knowledge, making knowledge management very important.
Role of Knowledge Management in Healthcare
• To boost operational efficiency by cutting patient’s wait time & help provide better services.
• Empowered decision making by healthcare providers due to readily available information.
• To avoid mistakes due to standardized procedures & accessible training.
• To allow secure collaboration among healthcare providers using critical information .
• To build a conducive learning environment within organization.
• Stimulates cultural change and innovations.
Benefits of Knowledge Management
• The healthcare industry is complex, expansive, and relies on knowledge to serve patients.
• Knowledge Management (KM) system is increasingly crucial to health care organizations across
the board.
• The benefits of knowledge management in healthcare are mentioned as below.
• Educated and empowered decision-making from information overload
• Avoiding medical malpractice
• Encourages collaboration between medical professionals while protecting patient confidentiality
• Encourages learning environment in the healthcare organization
• Drives digital transformation in healthcare
• Encourages innovation
 Barriers to Adoption of Knowledge Management
• Infrastructure/ Technological constraints in healthcare facilities
• Huge initial investment
• Limited access to modern technologies
• System unreliability
• Poor interface usability and problem with accessing health IT applications
• Lack of support from management or failure to see the importance of KM systems
• Lack of motivation among employees to share knowledge
• Reluctance to use ICT tools daily due to time constraint
• Lack of attention to the results
• Limited documents and use of good practices
• Inadequate awareness about KM systems
• Poor quality of data/ lack of incentives for proper documentation
• Lack of centralized knowledge base system
• Lack of communication between researchers and policy makers

ICT – Information & Communication Technologies

IT – Information Technologies
KM – Knowledge Management
Systematized Nomenclature of
Medicine
SNOMED
• Systematized Nomenclature of Medicine (SNOMED) is a systematic, computer-processable
collection of medical terms to provide codes, terms, synonyms and definitions which cover
anatomy, diseases, findings, procedures, microorganisms, substances, etc.
• SNOMED allows a consistent way to index, store, retrieve, and aggregate medical data across
specialties and sites of care.
• SNOMED was originally designed as an extension to Systematized Nomenclature of Pathology
(SNOP).
• SNOMED was started in the US by the College of American Pathologists (CAP) in 1973.
• SNOMED Reference Terminology (SNOMED-RT) was merged with, and expanded by, the
National Health Service's Clinical Terms Version 3 to produce SNOMED-CT (SNOMED - Clinical
Terms) in 2002.
• In 2017, all SNOMED versions except SNOMED CT were deprecated by International Health
Terminology Standards Development Organisation (IHTSDO).
ICD-10-CM
• ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) is to classify and
code all diagnoses, symptoms and procedures recorded in conjunction with hospital care.
• ICD-10-CM is based on the International Classification of Diseases, published by WHO.
• It uses unique alpha-numeric codes to identify known diseases and other health problems, storage and
retrieval of diagnostic information.
• The structure of ICD-10-CM codes:
• First character: Alpha character, excluding ‘u’.
• Second & Third characters: Numeric.
• Fourth to Seventh characters: Mix of alpha and numeric characters.

• Significance of the characters:

• First to third characters categorize the injury.
• Fourth to sixth characters describe in greater detail the cause, anatomical location and severity of an injury or illness.
• The seventh character is an extension digit, to classify an initial, subsequent or sequela (late effect) treatment
encounter.
• Example, F53.0 Postpartum depression; T43.641A Poisoning by ecstasy, accidental (unintentional), initial
encounter
SNOMED CT to ICD-10-CM Map
• The SNOMED CT to ICD-10-CM map can be used in real time by healthcare providers.
• Purpose of SNOMED CT to ICD-10-CM map is to support semi-automated generation of ICD-10-
CM codes from clinical data encoded in SNOMED CT, for reimbursement & statistical purposes.
• The clinician updates the problem list in the EHR, which is encoded in SNOMED CT, after an
initial encounter with the patient.
• The SNOMED CT to ICD-10-CM map-enabled problem list application outputs a list of ICD-10-
CM codes based on algorithmic evaluation of map rules.
• The clinician can be prompted for additional information or refining the output codes.
• The clinician then confirms the suggested ICD-10-CM codes.
Benefits of SNOMED CT
Benefits to population Benefits to individual patients
• Monitors population health and facilitates • Enables consistent recording of clinical information.
identifying emerging health issues. • Multilingual use is enabled by using SNOMED CT, thus
• Enables access & delivery of data to support removing language barriers.
clinical research and contribute evidence for • Enables support systems to provide real-time advice.
future improvements. • Enables collaboration among healthcare providers by
• Enables accurate access to relevant allowing easy sharing of information.
information, reducing costly errors and • Multilingual use is enabled by using SNOMED CT, thus
duplication. removing language barriers.

Adds value to EHR

Evidence-based healthcare
• Makes EHR meaningful via use of clinically
• Enables link between clinical records & clinical
validated, semantically rich, controlled
guidelines.
terminology.
• Enhances patient care quality.
• Allows meaning-based retrieval of information.
• Raises effectiveness of care.
• Reduces risk of errors.
• Reduces cost of duplicative testing and treatment.
Standard Nursing Terminologies
• Use of a Standardized Nursing Language (SNL) is vital for documentation of nursing care.
• SNL provides a standardized vocabulary to implement e-documentation & EHR, and describe key
components of care process, for smooth collaboration between healthcare providers.
• SNL is commonly-understood set of terms used to describe the clinical judgements involved in
nursing diagnoses, interventions, and outcomes related to the documentation of nursing care.
• North American Nursing Diagnosis Association (NANDA), formed in 1973, was a task force to
develop a standardized language for nurses.
• Nursing Minimum Data Set (NMDS) was developed in 1988 & Nursing Management Minimum
Data Set (NMMDS) in 1989.
• Clinical Care Classification (CCC) was developed in 1991 for use in hospitals, ambulatory care
clinics, and other settings.
• The standardized language developed for home, public health, and school health is the Omaha
System.
• The Nursing Intervention Classification (NIC) was published first in 1992.
Importance & Benefits of SNL
• Importance of Standard Nursing Language is:
• To facilitate communication among nurses
• Should facilitate comparisons across settings and locales
• Must support the visibility of nursing
• Should describe nursing outcomes by use of a computer-compatible coding system, to accomplish a
comprehensive data analysis
• Should evaluate the effectiveness of nursing care through measurement of nursing outcomes
• Benefits of Standard Nursing Language are:
• Better communication among nurses and other health care providers
• Increased visibility of nursing interventions
• Improved patient care
• Enhanced data collection to evaluate nursing care outcomes
• Greater adherence to standards of care
• Facilitated assessment of nursing competency
NANDA International
• NANDA International is a professional organization of nurses interested in standardized nursing
terminology.
• It develops, researches, disseminates and refines the nomenclature, criterion and taxonomy of
nursing diagnoses.
• The current structure of NANDA-I’s nursing diagnoses in referred to as Taxonomy II and has three
levels: Domains (13), Classes (47) and Diagnoses (237).
Nursing Interventions Classification (NIC)
• NIC is the first comprehensive classification of treatments performed by nurses.
• NIC is a standardized language of both nurse-initiated and physician-initiated nursing treatments.
• NIC is essential for computerized EHR for documentation and reimbursement.
• An intervention is defined as any treatment, based upon clinical judgment and knowledge, which a
nurse performs to enhance patient/client outcomes.
• NIC interventions include:
• Physiological (e.g. Pressure Ulcer Care) & Psychosocial (e.g., Anxiety Reduction)
• Illness treatment (e.g. Shock Management), Illness prevention (e.g. Fall Prevention), Health promotion
(e.g. Exercise Promotion)
• For individuals and for families (e.g. Family Support) and for entire communities (e.g. Environment
Management)
• Indirect care interventions (e.g., Emergency Cart Checking, Supply Management)
NIC…Contd.
• Each intervention is listed with a label name, a definition, a set of activities to carry out the
intervention, and background readings.
• The 565 interventions in NIC (VII edition) are grouped into thirty classes and seven domains for
ease of use.
• 7 domains in NIC are Physiological: Basic, Physiological: Complex, Behavioural, Safety, Family,
Health System, and Community
• NIC is useful for:
• Clinical documentation
• Communication of care across settings
• Integration of data across systems and settings
• Effectiveness research
• Productivity measurement
• Competency evaluation
• Curricular design
Omaha System (OS)
• OS was developed in 1970s by practitioners at Visiting Nurse Association (VNA) of Omaha.
• It is standardized terminology for clinical information documentation & to support healthcare research.
• The Omaha System is highly regarded because:
• It is research-based & extensively tested for reliability and validity.
• It is created specifically to describe community healthcare.
• It is designed to be used in electronic documentation.
• The Omaha System was originally based on the problem-solving approach, “Problem – Intervention –
Outcome”.
Components Terms Purpose
4 domains
Organize assessment (needs and
42 problems
Problem Classification Scheme strengths) for individuals, families,
2 sets of modifiers
and communities
Clusters of problem specific signs/symptoms
4 categories Organize multidisciplinary
Intervention Scheme 75 targets and 1 other practitioners’ care plans and the
Client-specific information services they deliver
3 concepts Evaluate individual, family, or
Problem Rating Scale for Outcomes
5-point Likert-type scale community change over time
Benefits of Standardized Languages
• Better communication among healthcare providers both nationally and internationally
• Increased visibility of nursing interventions & highlighting contribution of nurses
• Improved patient care through better diagnosis
• Enhanced data collection to evaluate nursing care outcomes
• Greater adherence to standards of care
• Assessing nursing competency
Summary
• Knowledge Management is the practice of harnessing and building upon a core set of knowledge to
enable an individual or a group of individuals to do their best work.
• Knowledge Management is needed to boost operational efficiency, empowered decision making,
secure collaboration, and stimulates cultural change and innovation.
• Knowledge management solution can enable doctors to immediately search for valuable
information that could impact a patient’s life positively.
• It also enables providers and staff to stay educated on the most up-to-date industry information,
and share best practices for processes and procedures.
• Standardized nursing languages provide a standardized vocabulary to implement e-documentation
& EHR.
• SNL describe key components of care process for smooth collaboration between healthcare
providers.
 Chapter – 16

e-Health: Patients & the Internet

Arashgeet Kaur
Learning Objectives
• Explain the use of information and communication technology in patient care
• Describe the application of public health informatics
Chapter Outline
• Use of ICT in healthcare
• Benefits of ICT in Healthcare
• Barriers in using ICT in Healthcare
• E-Health
• Introduction to Public Health Informatics
• Role of Nurses in Public Health Informatics
Information and Communication
Technology (ICT)
Introduction to ICT
• Information and communication technology (ICT) deals with well-designed and sophisticated
hardware & software engineering.
• ICT improves the quality of patient care, increases patient security and data protection.
• ICT reduces administrative as well as operational cost.
• Growing use of telecommunication devices has led to fast adoption of ICT for health care services
among masses.
• Health ICT seeks to prevent illness, treat diseases, and manage chronic illness.
• Health ICT aims to improve healthcare for individuals and communities.
• It provides capacity for system efficiencies and prevent medical errors.
• It allows for remote care, interdisciplinary clinical support, and knowledge support.
• It helps to bridge the urban – rural disparities in providing healthcare.
Use of ICT in Healthcare
Health & Education
• ICT makes education accessible, available and open to all.
• Health education creates awareness among the public about diseases, health status, procedures, prevention
measures, etc.
• People can choose hospitals & doctors for treatment and choose to lead their life in a healthy way.

Hospital Management System

• ICT makes software available for hospital management.
• It helps to improve the patient safety and satisfaction.
Health Research
• ICT helps form new models for effective and quality patient care.
• ICT helps in finding the possible prevention measures to eradicate and reduce the spread of diseases.
Health Data Management
• ICT in hospitals is used for electronic storage of medical data.
• Health data can be transferred to the patient or to doctors for consultation through ICT.
Benefits of ICT in Healthcare
• Transformation of healthcare by competently distributing public health information.
• Promote patient-centred healthcare with cutting down the cost.
• Enabling consultation in health issues for individuals.
• Improve the quality of care and information among health workers and users.
• Educate health professionals and patients via training and learning.
• Reduce travel time because of tele-medicine and tele-nursing.
• Enables patients to receive remote consultation, diagnosis, and treatment from specialists in
hospitals around the world.
• Monitor public health threats.
• Carry on new health models.
Barriers in Using ICT in Healthcare
• Lack of support from management due to failure of realizing the importance of ICT.
• Social and cultural resistance towards the adoption of ICT.
• Considerations of costs.
• Availability of expert staff i.e. staffing issue.
• Work practices and work culture.
• Capacity to manage change.
e-Health
e-Health
• e-Health: Use of ICT in health sector, to meet the needs of people, health providers, policy makers
& technocrats.
• e-health includes a range of services:
• E-health records
• CPOE
• E-prescription
• CDSS
• Telemedicine, Tele-nursing, Tele-rehabilitation, Tele-surgeries
• Consumer Health Informatics
• Health Knowledge Management
• M-health
• Medical Research Grids
• Health Informatics
• Objective of e-health: To provide medical facilities to the public at their door step, i.e. mobile
services at any time through web services and SMS.
CDSS - Clinical Decision Support System
CPOE - Computerized Physician Order Entry
10 E’s in e-Health
• Efficiency in healthcare by decreasing costs
• Enhancing quality of care
• Evidence based interventions
• Empowerment of consumers and patients
• Encouragement of a partnership between patient and health professional
• Education through online sources (continuing medical education) to consumers
• Enabling information exchange between health care establishments and consumers.
• Extending care beyond conventional boundaries
• Ethics during patient-physician interaction.
• Equitable services for all

In addition to these 10 essential e's, e-health should also be: Easy-to-use, Entertaining & Exciting
Importance of E-Health
e-Health provides answer to three key challenges:
• Support for Ageing Population
• e-Health and tele-care solutions are cheap methods of delivering care.
• e-Health allows to support and monitor aging population.
• Supports independent living for chronically-ill people with reduction of secondary care.
• Patient Safety
• E-health is a key element in implementation of knowledge management initiatives.
• Helps to reduce errors, improve patient experience and reduce costs.
• Patient Empowerment
• Health information allows consumers to make informed choices about their health.
• Open access to knowledge which was previously only available to health professionals.
Public Health Informatics
Introduction to Public Health Informatics
Public health informatics can be defined as
“the systematic application of information and computer science and
technology to public health including surveillance, prevention,
preparedness, reporting, health promotion, research, and learning.”

• A sub-domain of Health informatics.

• Inter-disciplinary profession that applies mathematics, engineering, information science & related
social sciences to public health problems and processes.
• Differentiated by its focus on populations, its inclination towards prevention & its governmental
context.
Categories of Public Health Informatics
Public Health Informatics
Study and description of complex systems which includes models of disease
transmission, public health nursing workflow, etc.
Categories of

Identification of contingencies to improve the efficiency and effectiveness of public

health systems by using innovative data collection and use of information.

System to achieve such improvements by implementation and maintenance of

process
Principles of Public Health Informatics
Main four underpinning principles of Public Health Informatics are:
1. Public health interventions have a great impact of the governmental context in which public
health is practiced.
2. Public health professionals explore the potential for prevention at all vulnerable points in all
factors of causal chains leading to disease, injury, or disability. Public health activities are not
restricted to particular social, behavioural, or environmental contexts.
3. The primary focus of public health is to promote the primary health care of populations and not
the health of specific individuals.
4. The primary strategy of public health informatics is prevention of disease and injury by
improving the conditions or the environment that pushes the populations at risk.
National Health Information Infrastructure (NHII)
• NHII: Comprehensive knowledge-based network of interoperable systems capable of providing
information for sound decisions about health when and where needed.
• Three domains of NHII:

Personal/ Consumer Community/ Public Health Clinical

• Standards Messaging Content • Ancillary health care systems • Decision Support Education
• Foundation for remainder of • Pharmacy • Professional
NHII • Laboratory • Consumer
• EMR Systems • Physical therapy • Confidentiality protections
• Hospital • Home health • Information available on need-
• Outpatient • Public health reporting to-know basis
• Consumer Health Information • Communication/networking • Authentication of all users
Systems systems • Encryption of data in transit
• Personal health record • Information moves with patient • Audit trails of all usage
• Electronic patient-provider • Integrated information from all • Penalties for violations
communication types of providers
• Support groups • Telemedicine
• Authoritative information
Benefits of Public Health Care Informatics
• Monitoring and protection of public health by rapid disease detection.
• Improvement in Patient Safety.
• Surveys and improvements helps to prevent the preventable deaths/year.
• Reduction in medication error.
• Improvement in quality of public health care.
• Supports Clinical Decision Support Systems.
• Helps the public/ community understand health care costs.
• Better informed health care counselling.
Barriers in Adoption of Public Health Care
Informatics
• Expensive and high risk projects.
• Interdisciplinary teams required.
• Resistance among public health managers to develop new skills.
• Unavailability of training material and guidelines.
• Relevant data not electronically available.
Role of Nurses in Public Health Informatics
• Nursing informatics is advancing rapidly as a scientific discipline.
• Primary goal of nursing informatics is to improve health of an individual, families & communities.

Hebda (1998) defines Nursing Informatics as

“the use of computers technology to support nursing, including clinical practice,
administration, education and research.”

ANA (American Nurses Association) 1994, has defined Nursing Informatics as

“the development and evaluation of applications, tools, processes and structures
which assist nurses with the management of data in taking care of patients or
supporting the practice of nursing.”
Implementation of Nursing Informatics
• Nursing Clinical Practice
• Nursing Administration
• Nursing Education
• Nursing Research
• Patient Education
• Clinical Alert System
• Patient Data
Summary
• Health ICT seeks to prevent illness, treat diseases, manage chronic illness while improving
healthcare, increase system efficiencies and prevent medical errors.
• The use of ICT in healthcare can be categorized into health & education, hospital management
system, health research and health data management.
• e-Health refers to the use of communication and technology in the health sector, to meet the needs
of people, health providers, professionals, policy makers and technocrats.
• Public health informatics can be defined as the systematic application of information and computer
science and technology to public health including surveillance, prevention, preparedness, reporting,
health promotion, research, and learning.
• NHII is a comprehensive knowledge-based network of interoperable systems which is capable of
providing information for sound decisions about health when and where needed.
• Nursing informatics is the use of computers technology to support nursing, including clinical
practice, administration, education and research.
 Chapter – 17

Using Information in
Healthcare Management
Arashgeet Kaur
Learning Objectives
• To describe the use of Nursing Information Systems
• To explain the use of Healthcare Data in Management of Healthcare Organization
Chapter Outline
• Healthcare Management
• Roles in Healthcare Management
• Nursing Information System
• Health Data Management
• Health Care Analytics
Introduction to Healthcare Management
• Healthcare Management is related to overall management of a healthcare facility.
• It is a broad term covering clinical directors, healthcare supervisors, health coordinators and
nursing home facilitators.
• A person involved in healthcare management has below functions typically:
• Creating work schedules for staff
• Planning and hiring for new staff
• Ensuring smooth and effective functioning of all departments
• Planning and directing non-clinical activities in the healthcare facility
• Managing budget and finances of the healthcare facility
• Assessing risk in the healthcare facility
• Ensuring that quality of care is top-notch
• Supervision of all the staff
Roles in Healthcare Management
• Healthcare Manager: Ensures smooth functioning of a healthcare facility in terms of budget,
needs of the community and goals of the healthcare providers.
• Health Information Manager: Ensures data input from healthcare providers is optimal and
assessable, and works with IT professionals to ensure that data is secure.
• Health Coordinator: Evaluates & monitors the quality of patient care, develops patient care plans,
documents the care provided and orders any necessary medical supplies.
• Clinical Director: Develops goals, leads and guides teams to reach the set goals, sets departmental
budgets and creates staff procedures within a healthcare facility.
• Hospital Manager: Oversees finances, communicates with stakeholders and ensures abidance by
laws.
• Health Supervisor: Responsible for business administration tasks (recording information, creating
staff schedule & keeping database up to date).
Nursing Information System (NIS)
• Nursing information includes data about the nursing activity and resources collected and used by
nurses.
• Nursing data is gathered during practice of nursing observation, nurse-client interactions, treatment
and test results.
• Nursing information is the transformation of data into an organized and meaningful structure.
• NIS is a part of healthcare information system that deals with nursing aspects, particularly
maintenance of nursing records.
• NIS combines nursing, information, and IT to process and manage data in nursing practice.
• NIS helps to overcome the constraints faced by nursing in taking decisions in absence of necessary
information.
• NIS is defined as computer system that manages and makes clinical data from a variety of
healthcare environments available in a timely & orderly fashion to aid nurses in improving patient
care.
Objectives of NIS
• Patient administration (admission, discharge, appointments, etc.)
• Reporting of the results and ensuring availability of patient-relevant data
• Ensuring availability of comprehensive automated information for nursing process
• Analysis of patient satisfaction
• Assessing risks, and recording of complaints and accidents
• Processing information for supporting management functions (e.g. policy decisions, operating
decisions, etc.)
• Staffing requirements and attendance
• Transferring patient information between different healthcare facilities
Functions of NIS

Patient Care Workload Assessment Rostering

• Nursing Clinical Records/ • Prospective workload • Staff rostering

Patient Charting planning • Recording attendance
• Care evaluation • Retrospective workload • Skill mix management
• Discharge planning planning • Budget Management
Components of NIS

Hardware Software Network

• Physical devices that • Series of programming • Devices & software that

provide handling statements that perform a help computer systems
functions. specific function and communicate and transfer
• Example: Input and output make up an application. data.
devices, CPU, and storage • Categorized into systems, • Network can be of three
devices. operating, application and types: WAN. LAN and
programming software. Wireless.
Designing of NIS
Need Analysis System Analysis Clinical Data Collection
• Expert group analysis • Analysis of working • Clinical data analysis
• Determination of plot of documentation • Review by expert group
computerization device • System Terminology
used

Designing and System Release System Updates &

Developing the System • Developing the module Upgrades
• Building basic data • Training of users • Feedback for updates
• Building database • Reviewing and
through results and modifying the system
intervention based on
nursing care plan
• Designing user interface
Utilization of NIS
Nursing Process Usage of NIS
• Using computer to note acceptance information
• Adding other information required by computer software
Assessment • Input data on patient’s health status and main complaint
• Input data on patient’s history
• Input data on any other relevant assessment
• Input of diagnosis with related signs and symptoms as references
Nursing Diagnosis • Obtaining information related to diagnosis after clinical assessment is determined for
the patient
• NIS displays suggested intervention for diagnosis and expected results
Planning • Assistance in writing the nursing plan
• Computer used to note intervention and patient’s information
Implementation • Communication among departments
• Computer used to note and save observations
• Patient’s response is noted towards nursing intervention
Evaluation • Recording statement of nurses’ evaluation
• New intervention noted in case of unsatisfactory results
Challenges in Adoption of NIS
• Slow pace of adoption due to less involvement of nursing profession in taking decisions in the past.
• Resistance to change among relevant stakeholders.
• Inability to see & understand benefits of adopting NIS among management.
Health Data Management
• Health Data Management: Systematic organization of health data in digital form.
• It integrates data to enable analysis to increase quality of patient care.
• It helps to derive insights from data to improve medical outcomes.
• It must also ensure data security and accessibility by relevant stakeholders only.
• Quality and quantity of healthcare data crucial to provide timely aid in serious situation.
• The health data includes but is not limited to:
• Patient demographics
• Medical notes
• Laboratory test results
• Procedures and surgeries
• Imaging, like X-rays, Computerized Tomography (CT), and MRI
• Diagnosis and Prescription
• Referrals and other communication
• Provider information
Importance of Health Data Management
• Logically organizing data for easy retrieval, especially in emergency situations.
• Complete and up-to-date patient data is crucial to provide quality patient care.
• Predicting health outcomes based on multiple variables describing the patient, using technology.
• Identifying trends and patterns in data to describe patterns on population-level for the authorities &
general public.
 Health Care Analytics
• Data analytics can help practitioners predict risks of infection, deterioration and readmission.
• It can help lower costs and improve patient care outcomes.

Descriptive Diagnostic Analytics Predictive Analytics Prescriptive

Analytics It is used to It uses current & Analytics
It uses historical data understand the historical data to It uses the given
for analysis for causes behind an make predictions & information, and
events that have event (e.g., to create models about Machine Learning to
already occurred & diagnose a patient the future. determine the best
to discover patterns. with an injury based course of action for
(e.g., to gain insight on his symptoms) the most ideal future
into an event) outcome.
Application of Data Analytics in Health Care
• Evaluating and developing practitioners in the identified areas of improvement.
• Increasing empathy among physicians for higher patient safety and fewer malpractice claims, by
using patient-reported data.
• Detecting anomalies to save both time & lives of patients.
• Predicting outbreaks using data analytics & allowing healthcare facilities to adequately prepare.
Use of Healthcare Data in Healthcare Facilities
• Different information required by health • The use of healthcare data can help make
planners and decision-makers: informed decisions in management of
• Health Determinants (Socio-economic, healthcare organizations:
genetic, environmental, behavioural factors) • Conducting early disease detection
• Environment in which health system is • Improving patient documentation
operating • Delivering tele-health services:
• Inputs to health system & related processes • Improving quality of outcomes
(policy, health infrastructure, facilities, etc. )
• Managing financial risk
• Outputs of the health system (Responsiveness
to user needs)
• Health outcomes (Mortality, health status,
disability, well-being)
• Health inequities (Coverage of use of services,
health outcomes)
Benefits of Health Data Management
• Predictive modelling by creating comprehensive view of patients & patient groups.
• Improved patient care through greater patient involvement and engagement.
• Improved health outcome on account of proactive measures to counter health issues.
• Data-driven decisions regarding staffing requirements, capital expenditure, training & education,
and marketing efforts.
• Physician alignment & suggestions on increasing the productivity.
• Meeting organization goals and realizing incremental revenues.
Challenges in Health Data Management
• Unavailability of data in a standard format across different platforms
• Quality of healthcare data
• Inability of software to support multiple formats to read/ store/ retrieve data at required time
• Frequent change in patient data subject to treatments and medication
• Chance of human error in collecting data
• Lack of standardization across different systems in different healthcare facilities
• Compliance to laws and regulation
• Data breach and security concerns for patients
• Huge storage capacity required to store patient history & current data
Summary
• Healthcare Management is the discipline related to overall management of a healthcare facility.
• A person involved in healthcare management typically plans, hires, creates schedules, and
supervises the staff.
• Nursing Information includes data collected and used by nurses; data about the nursing activity,
and data about the nursing resource.
• The objective of Nursing Information System (NIS) is patient administration, ensuring patient data
is available and analysis of patient satisfaction.
• NIS combines nursing, information and IT to manage data that further acts as knowledge for
nursing practice.
• The involvement of high cost hinders the adoption of NIS.
• Healthcare Data Management uses different information to help decision makers conduct early
disease detection, deliver telehealth services, and improve quality of the outcomes.
 Chapter – 18

Information Law &

Governance in Clinical Practice
Arashgeet Kaur
Learning Objectives
• To describe the ethical and legal issues in healthcare informatics
• To explain the ethical and legal issues related to nursing informatics
Chapter Outline
• Importance of Digital Health
• Ethical Complications connected to Nursing Informatics
• Legal Aspects in Nursing
• Legal Safeguards for Nurses
• Data Protection
Digital Health
• Digital health applies digital transformation to healthcare in cooperating software, hardware and
services (mobile health apps, EHR, wearable devices, tele-health, etc.)
• Advances in interoperable data and technology ensure right treatment at right time for patient.
• Digital health reduces medical errors, aids preventive care & increases staff efficiency.
• Nursing informatics integrates the science of medicine and analytics to identify, manage, track and
send knowledge and information, such as
• Care protocols
• Communication notes from healthcare team
• Diagnostic tests and their results
• Nurses' notes
• Financial reports
• Medical notes and news
• Patient health history
• Schedules
Ethical Complications in Nursing Informatics
• EHRs are replacing paper documents gradually.
• EHRs are stored electronically and are prone to data breach or data security concerns.
• Nursing Informatics can create ethical dilemmas for nurses, if information is not secured or is
misused.
• Violation of privacy laws and regulations may include:
• Failing to log off a computer when not in use
• Illegally surfing the patient files
• Lending passwords or codes to the others
• Loss of electronic devices
• Printouts of private information is not secured
• Texting patients' information to an unauthorized person
Legal Aspects in Nursing
• Laws are important in nursing.
• Laws protect the basic rights of patients as well as the rights of nurses.
• It provides framework for actions and reactions of the nursing activities within legal rights.
• Major legal issues in nursing practice are:
• Negligence towards profession/client
• Invasion of privacy
• Deformation of character in any way
• Assault, battery and fraud
• Malpractices
• Nurses are also bound by professional laws, constitutional laws, constitutional policies and rules
and regulations:
• License to practices by accredited bodies like Indian Nursing Council and State Nursing Council
• Professional code of conduct
• Institutional policies to regulate nursing practices
Legal Safeguards for Nurses
• Nurses can protect themselves with the adoption of legal safeguards.
• Some basic guidelines are as follows:
• Obtaining informed consult
• Physician orders/standing orders (in written form)
• Ensure correct identify of patient/client.
• Accurate and in time documentation.
• Negotiation with employers.
• Drug maintenance especially narcotic drugs.
• Reporting of crimes, torts or unsafe practices
Ethics & Health Informatics
• Internet, Cloud Computing, Social Networks & Mobile Technology, etc. are all part of medical
information & healthcare information exchange between doctors and patients.
• They facilitate smooth and optimum communication & flow of information.
• Important to understand ethics and health informatics:
• Ethics: Ethics is study of good conduct, character and motives. It determine one’s behavior.
• Health informatics: Scientific field that deals with resources, devices and formulized methods of
solving and decision making.
• The increasing use of new technologies in healthcare sometimes creates ethical dilemmas, usually
related to responsibility, trust, privacy and security.
• Ethical dilemma is a conflicting situation for selecting one out of two or more courses of action
having some significant consequences.
• Professional critical thinking power & knowledge of ethical principles and theories is required to
overcome ethical dilemma.
• Health informatics not only resolves ethical conflicts but also prevents them.
Need of Ethics in Healthcare Informatics
• Healthcare professionals may face issues regarding legal & ethical use of software in appropriate
disclosure of patient disease or medical data.
• Ten main ethical issues which can be faced regarding legal or any other issue:
• Patients' rights
• Equity of resources
• Confidentiality of patients
• Patients' safety
• Conflict of interest
• Ethics of privatization
• Informed consent
• Dealing with opposite sex
• Beginning and end of life
• Health care team ethics
• Knowledge of ethics help both the health professionals and the patient to stay safe.
Information Technology in Healthcare
• Main purpose of IT in healthcare is to improve patient safety and quality.
• This helps reduce morbidity and mortality among patients.
• It helps to reduce human errors and increases the efficiency in professional care.
• It enhances the doctor patient relationship through communication.
• It gives the patients danger alarms, alerts and reminders.
• The information system in clinical setup is as below:
• EMR: These provide medical history, diagnosis, medications, immunizations, allergies, lab results and
doctors note etc. This is mostly used by the providers for diagnosis, further treatment.
• Point Of Care (POC) system: It is the OPD patient information system that includes medical facilities
provided to the patient near location like, self-testing, pharmacy etc.
• Decision support system: A variety of technologies ranging from simple alerts, prescription of drugs,
clinical pathways and protocols.
• Telemedicine: Use of electronic information to communicate and support healthcare from a distance.
IT in Healthcare… Contd.
• Parameters to be considered by healthcare professional, while using technologies in contemporary
clinical practice:
• Knowledge between ethics and laws
• Implementation of contemporary ethical principles by examining the difference between duties.
• Knowledge of actions that pertain to the principles of ethics.
• Understanding common terms and principles of modern bioethics.
• Utilization of ethical principles as guidelines for decision making for patients and clients.
• Knowledge of the ethical decision-making models to come out of ethical dilemma.
• Identifying ethical duties and actions while obtaining informed consent from patient/ family.
• Exploring positive communication techniques to use for information and consent.
• Safe guarding of medical records and contents.
• Understand the ethics pertaining to different cultures.
Ethical & Legal Aspects of Healthcare System
• Confidentiality: Disclosing personal information of any patient without the informed consent, and
to unauthorized personnel is illegal & unethical.
• Avoiding harm: Any type of physical or mental harm to the patient visiting a healthcare facility is
illegal & unethical.
• Obtaining informed consent: Legal right of the patient to know procedure to be undertaken & it
is the responsibility of the professional to make patient understand & take consent.
• Professional relationships between doctor-patient: Patient has the right to expect high
professional services from the health care system.
• Financial arrangement for financially weaker patients: Arranging donations & help from
government schemes for the needy is the required ethical behavior of the health professional.
• Providing services to patients served by other health professionals: Equitable health services
for everyone without discrimination of color, creed, caste & financial status is the law of country.
• Maintaining proper records, reports and data related to clients or patients: Patient should be
intimated about recording of parameters before/ after treatment; and have legal right to their data.
Data Protection
• Data protection is a major concern as privacy of the patients records and reports is their legal right.
• Three main rationale of data protection are:
• Keeping information of the patient's life medical history in strict confidence.
• Data collected for statistical analysis (e.g. conducting health survey) should not be used for identification
of the person.
• Data integrity should be maintained.
• There are several privacy risks in case of providing e-health services.

Exploitation of Internet privacy & Hampering of tele-medicine due to

confidentiality technological risks

• Forwarded mails • Quality of images not appropriate to

• E-mail addresses logs the condition
• Snippets of information compiled from • Lack of suitable equipment or
multiple sources malfunctioning equipment
• Inadequate guidelines
Security Management
• e-Health services should be made more secure to increase patient’s confidence in availing the
services.
• Acceptance of e-Health services is convenient for the patient and increases his involvement.
• Acceptance of e-Health services reduces the load of occupancy in healthcare facilities.
• The security management of health information technology should consider as below:
• Use of secure network
• User authentication by the system
• Access for a user based on the requirement
• Maintaining an activity log for all users logging into a system
• Use of filter for incoming and outgoing data based on type of origin or destination.
Summary
• Advances in interoperable data and technology is bringing major changes in healthcare.
• They help to ensure right treatment and interventions are delivered at the exact moment needed by
the patient.
• Nursing informatics is the major component of modern healthcare.
• It integrates the science of medicine and analytics to identify, manage, track and send knowledge
and information.
• With the implementation of technology, the healthcare professionals need to take care of legal and
ethical issues.