CHAPTER 5

HOSPTIAL/HEALTHCARE INFORMATION SYSTEM AND NURSING INFORMATION

SYSTEM

LESSON 1: HOSPTIAL/HEALTHCARE INFORMATION SYSTEM

HEALTH INFORMATION SYSTEMS/ HIS

• a broad term generally used when referring to electronic systems designed to manage
healthcare data.
• the system in which collection, utilization, analysis and transmission of information is
done for conducting health services, training and research.
• A combination of hardware, software, and telecommunications networks that is used to
collect, create, and distribute useful data, typically in organizational settings.
• HIS have a strong influence in quality and efficiency in health care. As technology
progresses more advanced opportunities arise to support health care.

In health facilities:
• Increases administration efficiency
COMPONENTS OF HIS
• Streamline management processes
• Enhances the quality of care
INPUTS = HIS resources
PROCESSES = Indicators, Data sources, Data Management
IMPORTANCE OF HEALTH INFORMATION SYSTEM OUTPUT = Information products, Dissemination and utilization

Produces information needed by: Information Processing as a quality factors

• Patients, communities, service providers, program managers, policy- makers, ✓ Decisions of health care professionals are based on vast amounts of information about
global agencies/ sponsors and organization. the patient’s health state.
Information used for Information Processing as a cost factor
• Better management ✓ Information processing in health care is an important cost factor and considerably
• Detect and control emerging and endemic health problems significant for national economy
• Monitor progress towards health goals; promotes equity Information Processing as a productivity factor
• Strengthen the evidence base for effective health policies. ✓ Increasingly important for the competitiveness of hospitals
• Improve management relate to mobilizing new processes

BENEFITS OF INFORMATION SYSTEM

• Communication
• Globalization and cultural gaps
• Availability
• Greater productivity
• Reduce risk and error
• Quality and safety

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EFFECTS OF ICT ➢ Mostly used by hospitals (labs, pharmacies, radiology, and ICU), can include health
The use of computer- based tools in the health care and new and advance technologies will history, prescriptions, doctor’s notes and dictation
proliferate
Computer- based training systems will strongly support efficient learning for health care
professionals 3. Practice Management System (PMS)
Documentation efforts will continuously rise to more sophisticated computer- based ➢ Commonly used by allied healthcare professionals such as psychologists,
documentation tools physiotherapists, and nurses
Decision support tools will support high quality care
➢ Helps to manage the day- to – day operation of a clinic (online booking, billing, patient
Communication will be highly supported by electronic means
reminders, and other admin tasks)
ADVANTAGES OF HEALTH INFORMATION SYSTEM ➢ Mostly used by hospitals (labs, pharmacies, radiology, and ICU), can include health
Data centralization history, prescriptions, doctor’s notes and dictation
Increased efficiency ➢ Other features: video sessions, clinical notes, online forms, integration
Security and confidentiality
Storage and Access Capabilities 4. Patient Portals
Increased accuracy
➢ Provides online access to the patient’s personal information, including previous
DISADVANTAGE OF HEALTH INFORMATION SYSTEM appointments, medical history, diagnoses, and more
High cost ➢ Can be accessed through any device (mobile phones, desktop, laptop, tablet) as long as
- Hardware and the software/ system there is an internet
- Training of users and maintenance
➢ Patient can also book appointments and contact their healthcare providers directly

DIFFERENT TYPES OF HEALTH INFORMATION SYSTEMS 5. The Master Patient Index (MPI)

➢ Electronic database that provides patients with a unique identifying number based on
1. EHR (Electronic Health Record) & EMR (Electronic Medical Record)
their geo- location. It allows patient to be cross- referenced between healthcare
EHR (Electronic Health Record) EMR (Electronic Medical Record) providers and systems- whether they be hospitals, physicians, labs, or imaging clinics
➢ Can be classified as a digital record ➢ Electronic Medical Record of a patient ➢ By storing the patient information within the system, healthcare records can be shared
➢ Complete overview of patient health is stored in the physician’s e- system. more efficiently and cost- effectively
history ➢ Used mostly by primary care
➢ Contains everything to include the physicians and specialists 6. Remote Patient Monitoring
EMR, visits to other healthcare ➢ Includes: (diagnosis, allergies, ➢ Helps reduce hospital confinement or readmissions by allowing patients to check their
professionals, insurance information, medications, family history, surgery medical status outside hospital or clinic using medical device.
records of hospitalization, and more information, progress notes) ➢ Allows healthcare providers to monitor their patients’ health status from afar, with
➢ Streamline patient’s data across access to video conferencing in order to improve overall patient care.
various doctors and health care ➢ Applicable in health conditions such as: high/ low BP, spiking or dropping sugar level,
providers, even outside practice unhealthy increase or decrease in weight, abnormal oxygen saturation level.

7. Clinical Decision Support Tools

2. Clinical Information System (CIS)
➢ Designed to breakdown a large amount of digital data and suggest “next steps” for
➢ Designed to rapidly capture, store, process and transfer information across decision- treatments. They can alert healthcare providers to information they may be unaware of
makers. and catch potential problems in advance. (ex: patient dangerously combining
➢ The system’s biggest benefit is to allow communication across different systems, and medications)
can export/ import data between instruments. ➢ It also filters information to assist healthcare providers in caring for individual clients

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 Records are readily accessible needed for accreditation purposes or to monitor contract
8. Laboratory information system (LIS) compliance
The information may be retrieved on a daily basis for use in conjunction with workload
➢ Allows doctors and lab tech/ med tech to coordinate inpatient and outpatient tests for
measurement and contract requirements to plan staffing assignments.
microbiology, hematology, chemistry, and immunology to obtain clinical data.
➢ How? The standard information system for a laboratory manages patient’s
demographics, check-in information, specimen entry and processing, and results OTHER ADVANTAGES OF NURSING INFORMATION SYSTEM

A. NURSING ADMINISTRATION
Evaluate quality assurance programs
LESSON 2: Nursing Information System Defend resource allocation to nursing
Demonstrate the contribution nursing makes to the care of the patient
Nursing Information System (NIS) Identify outcomes of nursing care

NIS are computer systems that manage clinical data from a variety of healthcare environments, B. NURSING PRACTICE
and made available in a timely and orderly fashion to aid nurses in improving patient care. Enhance documentation by nurses
Provide data to enable research directed at examining the interrelationships between data
Emphasizes patient safety via installation of systems that focuses on reducing errors in elements and nursing outcomes
healthcare Facilitate development of nursing process
The main tasks in nursing care process include: processes of patient care; ward management;
communication; cooperation with other health professionals; education and research processes.
C. NURSING RESEARCH
To assess variables on multiple levels including institutional, local, regional, and national.
APPLICATION OF NURSING MANAGEMENT INFORMATION SYSTEM Identify trends to build information and to further synthesize to develop nursing knowledge

A. Workload Measurement and Staffing Requirements D. NURSING EDUCATION

It helps store, manipulate, and retrieve large volumes of data To develop body of knowledge with focus on nursing process
The information generated assists nursing managers in planning, monitoring and evaluating use To enable staff educational needs based on follow up care and outcomes
of nursing resources on a daily basis and in the longer time frame To enhance student nurses’ accurate documentation
It is used to generate staff scheduled in conjunction with personnel management

B. Annual Resource Management CHAPTER 6

The information generated can be used to monitor past performance or to predict future INTELLECTUAL PROPERTY RIGHT AND COPYRIGHT
performance
Accumulated data can be analyzed for the development of trends that can be used to project
future expenditures INTELLECTUAL PROPERTY RIGHT
Necessary reallocations and budgetary adjustments can then be made on the basis of THE IPR CONTEXT
projections and appropriations.
• According to the World Intellectual Property Organization (WIPO), intellectual property
C. Staff scheduling (IP) is divided into two categories, namely, industrial property and copyright. Industrial
Nursing managers are able to plan schedules in advance with considerable time savings. property includes inventions (patents), trademarks, industrial designs, and geographic
Staffs are informed ahead of time indications of source; while copyright includes literary and artistic works such as novels,
Staffing records, if maintained properly, provide useful information for monitoring attendance, poems and plays, films, musical works, artistic works such as drawings, paintings,
scheduled time off, and turn over or endorsements photographs and sculptures, and architectural designs.
• However, exclusive rights of the scientists, researchers, inventors, artists, and other
D. Personnel Management gifted citizens in our country are not suitably protected as they should be. Most of them
Knowing the skills and competencies of nurses have apprehensions in applying for intellectual property rights.

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INTELLECTUAL PROPERTY RIGHT (IPR) NON-PATENTABLE INVENTIONS

The term "intellectual property rights" consists of: • Discovery

• Copyright and Related Rights • Scientific theory
• Trademarks and Service Marks • Mathematical methods
• Geographic Indications • Scheme, rule and method of
• Industrial Designs • performing mental act
• Patents • playing games
• Layout-Designs (Topographies) of Integrated Circuits • doing business
• Protection of Undisclosed Information • program for computer
• Method for treatment – human or animal body by surgery or therapy & diagnostic
GOVERNMENT AGENCIES method
• Plant variety or animal breed or essentially biological processes for the production of
The agency of the government in charge of the implementation of the Intellectual plants and animals
Property Code is the Intellectual Property Office which replaced the Bureau of Patents, • Aesthetic creation
Trademarks and Technology Transfer. It is divided into six [6] Bureaus, namely: • Contrary to public order or morality

• Bureau of Patents
• Bureau of Trademarks REQUIREMENT FOR PATENTABILITY
• Bureau of Legal Affairs
• Documentation, Information and Technology Transfer Bureau • NOVELTY
• Management Information System and EDP Bureau • INVENTIVE STEP
• Administrative, Financial and Personnel Services Bureau. • INDUSTRIAL APPLICABILITY

INTELLECTUAL PROPERTY OFFICE REQUIREMENTS FOR FILING A PATENT

The Intellectual Property Office of the Philippines (IPOPHL) is the lead agency
• Request for the Grant of Patent
responsible for handling the registration and conflict resolution of intellectual property
• Description of the Invention (Specification and Claim/s)
rights. It was created by virtue of Republic Act No. 8293 or the Intellectual Property • Drawings necessary for the Invention (if any)
Code of the Philippines, which took effect on January 1, 1998 under the presidency of • Filing Fee
Fidel V. Ramos.

PATENTS
• A Patent is a grant issued by the government through the TRADEMARKS
• Intellectual Property Office of the Philippines. It is an exclusive right granted for a "Mark" means any visible sign capable of distinguishing the goods (trademark) or
product, process or an improvement of a product or process which is new, inventive and services (service mark) of an enterprise and shall include a stamped or marked
useful. This exclusive right gives the inventor the right to exclude others from making, container of goods.
using, or selling the product of his invention during the life of the patent.
• A patent has a term of protection of twenty (20) years providing an inventor significant
A trademark is a tool used that differentiates goods and services from each other. It is
commercial gain. In return, the patent owner must share the full description of the
a very important marketing tool that makes the public identify goods and services. A
invention.
trademark can be one word, a group of words, sign, symbol, logo, or a combination of
any of these. Generally, a trademark refers to both trademark and service mark,
PATENTABLE INVENTIONS although a service mark is used to identify those marks used for services only.
Any technical solution of a problem in any field of human activity which is new, involves
an inventive step and is industrially applicable shall be patentable. TRADEMARK PROTECTION

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A trademark can be protected through registration. Registration gives the trademark Works are protected by the sole fact of their creation, irrespective of their mode or form
owner the exclusive right to use the mark and to prevent others from using the same or of expression, as well as their content, quality and purpose. Thus, it does not matter if,
similar marks on identical or related goods and services. in the eyes of some critics, a certain work has little artistic value. So long as it has been
independently created and has a minimum of creativity, the same enjoys copyright
Before applying for trademark registration, it would help if you conduct a search in the protection.
trademarks database to determine if there are identical or similar marks that would
prevent the registration of your mark. This is to prevent future conflicts with marks that WORKS COVERED BY COPYRIGHT PROTECTION
are already registered or with earlier filing dates.
• Books, pamphlets, articles and other writings
TRADEMARK REGISTRATION • Periodicals and newspapers
• Lectures, sermons, addresses, dissertations prepared for oral delivery, whether or not
• The name and address of the applicant reduced in writing or other material form
• The name of a State of which the applicant is a national or where he has domicile • Letters
• Where the applicant is a juridical entity, the law under which it is organized and existing • Dramatic or dramatico-musical compositions; choreographic works or entertainment in
• The appointment of an agent or representative, if an applicant is not domiciled in the dumb shows
Philippines • Musical compositions, with or without words
• Where the applicant claims the priority of an earlier application, an indication of: • Works of drawing, painting, architecture, sculpture, engraving, lithography or other
work of art; models or designs for works of art
The name of the State with whose national office the earlier application was filed or it • Original ornamental designs or models for articles of manufacture, whether or not
registrable as an industrial design, and other works of applied art
filed with an office other than a national office, the name of that office
• Illustrations, maps, plans, sketches, charts and three-dimensional works relative to
The date on which the earlier application was filed
geography, topography, architecture or science
Where available, the application number of the earlier application • Drawings or plastic works of a scientific or technical character q Photographic works
including works produced by a process analogous to photography; lantern slides
• Where the applicant claims color as a distinctive feature of the mark, a statement to that • Audiovisual works and cinematographic works and works produced by a process
effect as well as the name or names of the color or colors claimed and an indication, in analogous to cinematography or any process for making audio-visual recordings
respect of each color, of the principal parts of the mark which are in that color; • Pictorial illustrations and advertisements
• Where the mark is a three-dimensional mark, a statement to that effect • Computer programs
• One or more reproductions of the mark, as prescribed in the Regulations • Other literary, scholarly, scientific and artistic works.
• A transliteration or translation of the mark or of some parts of the mark, as prescribed in
the Regulations
TERM OF PROTECTION OF COPYRIGHT
• The names of the goods or services for which the registration is sought, grouped
according to the classes of the Nice Classification, together with the number of the class • In general, the term of protection of copyright for original and derivative works is the
of the said Classification to which each group of goods or services belongs life of the author plus fifty (50) years after his death. The Code specifies the terms of
• A signature by, or other self-identification of, the applicant or his representative. protection for the different types of works.
• In calculating the term of protection, the term of protection subsequent to the death of
the author shall run from the date of his death or of publication, but such terms shall
always be deemed to begin on the first day of January of the year following the event
COPYRIGHT which gave rise to them (i.e. death, publication, making).

COPYRIGHT INFRINGEMENT
Copyright is the legal protection extended to the owner of the rights in an original work.
Copyright infringement consists in infringing any right secured or protected under the
“Original work” refers to every production in the literary, scientific and artistic Code. It may also consist in aiding or abetting such infringement. The law also provides
domain. Among the literary and artistic works enumerated in the IP Code includes for the liability of a person who at the time when copyright subsists in a work has in his
books and other writings, musical works, films, paintings and other works, and possession an article which he knows, or ought to know, to be an infringing copy of the
computer programs. work for the purpose of:

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 • Selling or letting for hire, or by way of trade offering or exposing for sale or hire, This helps to ensure a fair return on investment. An effective system of protection also
the article benefits consumers and the public at large, by promoting fair competition and honest
• Distributing the article for the purpose of trade, or for any other purpose to an trade practices, encouraging creativity, and promoting more aesthetically attractive
extent that will prejudice the rights of the copyright owner in the work products.
• Trade exhibit of the article in public.
UTILITY MODELS
COPYRIGHT REGISTRATION A Utility Model is a protection option, which is designed to protect innovations that are
not sufficiently inventive to meet the inventive threshold required for standard patents
• A duly accomplished form in duplicate for each work, provided, that a separate application. It may be any useful machine, implement, tools, product, composition,
application is submitted for each number of a periodical containing a notice of process, improvement or part of the same, That is of practical utility, novelty and
copyright. industrial applicability.
• A support document evidencing ownership of the copyright, the manner of its
acquisition if the claimant is not the original author translator, or editor, and A utility model is entitled to seven (7) years of protection from the date of filing, with
where and in what establishment the work was made, performed, printed, or no possibility of renewal.
produced, and the date of its completion and publication.
• Receipt showing payment of the registration fee if the application is filed
personally, or by postal money order if the application is filed by registered mail.
• Documentary stamps in the correct amount, which shall be affixed to the
registration and deposit certificate. UTILITY MODELS—REGISTRATION
• Two (2) complete copies or reproduction of the work or replica or picture
• Two (2) printed copies with the copyright notice printed in front or at the back of An application for registration should contain a duly accomplished request for
the title page or on any conspicuous space for a non-book material, if the work is registration as prescribed by the Bureau, specification or description containing the
a published work. following:

INDUSTRIAL DESIGN • Title

• Technical field
An industrial design is the ornamental or aesthetic aspect of an article. The design may • Background of the Utility Model
consist of three-dimensional features, such as the shape or surface of an article, or of • Brief description of the several views of the drawings
two-dimensional features, such as patterns, lines or color. • Detailed description
• Claim or claims
Industrial designs are applied to a wide variety of products of industry and handicraft: • Drawings
from technical and medical instruments to watches, jewelry, and other luxury items; • Abstract of the disclosure.
from house wares and electrical appliances to vehicles ; from textile designs to leisure
goods.

To be protected under most national laws, an industrial design must be non- PHILIPPINE COPYRIGHT LAW
functional. This means that an industrial design is primarily of an aesthetic nature and
any technical features of the article to which it is applied are not protected.
Intellectual Property Code of the Philippines, or Republic Act No. 8293,
DESIGN PROTECTION specifically the Law on Copyright.

When an industrial design is protected, the owner – the person or entity that has • Is enshrined in the Intellectual Property Code of the Philippines, officially known as
registered the design – is assured an exclusive right against unauthorized copying or Republic Act No. 8293.
imitation of the design by third parties. • Law is partly based on United States copyright law
• Principles of the Berne Convention for the Protection of Literary and Artistic Works.

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• Also protect patents, trademarks, and other forms of intellectual property. payments related to the case
• There are laws that protect copyrights: the Optical Media Act (which protects music, vii. Seizure of the products that have been subject to infringement
movies, computer programs, and video games) is an example of such. viii. Forfeiture of all paraphernalia and properties (whether real or personal) involved
• Enforced through a body established by the law: the Intellectual Property Office, or with the infringement
IPO, and its various branches. ix. Imposition of administrative of fines no less than 50,000 pesos but no more than
• Implementation is done with the coordination of the IPO and the Copyright Division of 300,000 pesos. For every day of continued violation, a fine of 5,000 pesos is
the National Library of the Philippines. imposed.
x. Cancellation of any document (permit, registration, etc.) attributed to the product
at the discretion of the Director of Legal Affairs
xi. Withholding of any document pending approval of the Bureau from the
respondent (the copyright violator)
xii. Assessment of damages
xiii. Censorship of the product
xiv. Other penalties in line with Executive Order 983 (1983)

THE PHILIPPINE DATA PRIVACY ACT OF 2012

DATA PRIVACY IS ABOUT

1. People, not Places

2. Personal Choice
3. Control, not Secrecy
4. The right to be left alone

THE 4th INDUSTRIAL REVOLUTION

• Data as the new oil of the digital economy

The Intellectual Property Code gives the power of mediating copyright problems
(before, during, and after the copyright application process) to a bureau of the
Intellectual Property Office known as the Bureau of Legal Affairs, as covered by Section
10 of the code. This body is empowered with the following functions:
1. Hear objections on items being applied for copyright

2. Address copyright violations where damages are no less than 200,000 pesos
a. Give the following penalties for copyright violations:
i. Issue cease and desist orders which have a fixed time where the copyright violator
must stop violating the copyright being infringed
ii. Accept voluntary orders of compliance or discontinuance as ordered by the
Director of Legal Affairs which must consist of the following:
iii. Assurance to comply with the intellectual property law violated
iv. Assurance to refrain from unlawful activity on the case being investigated v.
Assurance to refund, replace, recall, or repair defective products vi. Assurance to
reimburse the complainant (usually the copyright holder) of all charges, fees, and

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 PROBLEMS ENCOUNTERED BY INDIVIDUALS during PROCESSING PERSONAL
INFORMATION

• Loss of trust
• Loss of self- determination
• Loss of liberty
• Exclusion
• Physical harm
• Discrimination
• Stigmatization
• Power imbalance

What does the LAW say?

The law upholds the right to privacy by protecting individual personal information.

The National Privacy Commission protects individual personal information by regulating

the processing of personal information.

THE SCOPE OF DPA 2021

Section 4: Applies to the processing of all types of personal information, in the country
and even abroad, subject to certain qualifications.

PERSONAL INFORMATION

DATA PROTECTION • Any information whether recorded in a material form or not, from which the identity of
an individual is apparent or can be reasonably and directly ascertained by the entity
• Confidentiality holding the information, or when put together with other information would directly and
• Availability certainly identify an individual.
• Integrity • Section 12 of the Act provides conditions under which processing Personal Information is
• Compliance ALLOWED.

SEC. 12: The processing of personal information shall be permitted only if not otherwise
prohibited by law, and when at least one of the following conditions exists:
DATA PRIVACY (a) The data subject has given his or her consent;

• Accountability (b) The processing of personal information is necessary and is related to the fulfillment
• Assurance of a contract with the data subject or in order to take steps at the request of the data
• Operational Compliance subject prior to entering into a contract;
• Demonstrable Compliance
(c) The processing is necessary for compliance with a legal obligation to which the
personal information controller is subject;

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(d) The processing is necessary to protect vitally important interests of the data subject, PROCESSING
including life and health;
Any operation of any set of operations performed upon personal data including, but not
(e) The processing is necessary in order to respond to national emergency, to comply limited to, the collection, recording, organization, storage, updating or modification,
with the requirements of public order and safety, or to fulfill functions of public retrieval, consultation, use, consolidation, blocking, erasure or destruction of data.
authority which necessarily includes the processing of personal data for the fulfillment
of its mandate; or

(f) The processing is necessary for the purposes of the legitimate interests pursued by
the personal information controller or by a third party or parties to whom the data is
disclosed, except where such interests are overridden by fundamental rights and
freedoms of the data subject which require protection under the Philippine Constitution.

SENSITIVE PERSONAL INFORMATION

(1) race, ethnic origin, marital status, age, color, and religious, philosophical or
political affiliations;

(2) health, education, genetic or sexual life of a person,

(3) civil, criminal or administrative proceedings

(4) Unique identifiers issued by government agencies peculiar to an individual

PERSONAL INFORMATION CONTROLLER
(5) Specifically established by law as classified

• A natural or juridical person, or any other body who controls the processing of personal
Note: Section 13= Processing of Sensitive Personal Information is prohibited except in the data, or instructs another to process personal data on its behalf.
following cases… • It excludes:

- A natural person who processes personal data in connection with his or her personal, family,
or household affairs

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OBLIGATIONS of PICs DATA PRIVACY PRINCIPLES
1. The PIC should collect personal information for specified and legitimate purposes
determined and declared before, or as soon as reasonably practicable after collection
2. The PIC should collect and process personal information adequately and not excessively
3. The PIC should process personal information fairly and lawfully, and in accordance with
the rights of a data subject
4. The PIC should process accurate, relevant and up to date personal information.
5. The PIC should retain personal information only for as long as necessary for the
fulfillment of the purposes for which the data was obtained. The information should be
kept in a form which permits identification of data subjects for no longer than is
necessary

PERSONAL INFORMATION PROCESSOR

• Any natural or juridical person or any other body to whom a personal information
controller may outsource or instruct the processing of personal data pertaining to a data
subject.

DATA SUBJECT A data subject must be aware of the nature, purpose, and extent of the
processing of his or her personal data, including the risks and safeguards involved, the
An individual whose personal, sensitive personal or privileged information is processed. identity of personal information controller, his or her rights as a data subject, and how
these can be exercised. Any information and communication relating to the processing
Right to be Informed
of personal data should be easy to access and understand, using clear and plain
Right to Access
language.
Right to Object
Right to Rectification
Right to Erasure or Blocking
Right to Damages
Right to Data Portability
Right to File A Complaint

The processing of information shall be compatible with a declared and specified

purpose, which must not be contrary to law, morals, or public policy.

CONSENT OF THE DATA SUBJECT

Refers to any freely given, specific, informed indication of will, whereby the data subject
agrees to the collection and processing of personal information about and/or relating to

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him or her. Consent shall be evidenced by written, electronic or recorded means. It may
also be given on behalf of the data subject by an agent specifically authorized by the
data subject to do so.

• Evidenced by written, electronic or recorded means:

ü signature
ü opt-in box/clicking an icon
ü sending a confirmation email Granular Consent
ü oral confirmation

The processing of information shall be adequate, relevant, suitable, necessary, and not
excessive in relation to a declared and specified purpose. Personal data shall be
processed only if the purpose of the processing could not reasonably be fulfilled by
other means.

Unbundled Consent THE FIVE PILLARS OF COMPLIANCE

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 Surbhi provides an example to understand confidentiality easily like one's bank details like
account number or ATM pin or user id and password of any social networking site or an email
account.

Specifically, the following are the major differences between privacy and
confidentiality (Surbhi 2018):

*Privacy is a situation when a person is free from public interference. Confidentiality is a

situation when information is kept secret from the reach of any other person.

*Privacy talks about a person, but Confidentiality is about information.

*Privacy restricts the public from accessing the personal details about a person, whereas
Privacy vs Confidentiality Confidentiality protects the information from the range of unauthorized persons.

Privacy is the state when an individual is free from public interruption and intrusion. The word *In privacy, everyone is disallowed from interfering in the personal matters of a person.
privacy is derived from the word 'private' which means the role of the public is limited, so the Conversely, in confidentiality some specified and trustworthy people are allowed to have access
term privacy refers to a condition where a person is apart from public attention and to the information.
observation. It is the right of every individual to be left alone in his personal matters because
everybody has his personal life. He can draw a boundary on the access of his information from *Privacy is at the voluntary; it is the choice of a person. In contrast to Confidentiality, it is
the use of others (Surbhi, S., 2018). compulsory if the relationship between parties is a fiduciary.

Moreover, Surbhi states that it is a human tendency to hide certain facts about himself or else *Privacy is a right. However, Confidentiality is an agreement.
people will use them against him.
In conclusion, Privacy and Confidentiality are the two terms which are commonly juxtaposed
In addition, Surbhi believes that privacy is a matter of choice of an individual if he doesn't want with each other. Privacy is about personal or private i.e. the range will be limited to yourself
to disclose his / her matter in front of people. For example, It is quite logical that ifa person only while if we talk about confidentiality, it is professional. The range will be limited the
wants to take a bath or change his clothes or he wants to have a personal conversation with persons, to whom the individual has trust There are only a few differences between the two
someone he will seek some privacy because he does not want anybody's interference in his terms, but Confidentiality is an advanced version of Privacy (Surbhi, S., 2018).
private moments. A good example of Internet privacy is here; you can set privacy on your social The Importance of Preserving Anonymity, Confidentiality and Privacy of Health
networking site account to limit the access of your personal stuff like who can see your stuff, Information are as follows:
profile picture, photos etc. (Surbhi, S., 2018).
1. To ensure safe and compassionate nursing practice that includes an understanding of the
On the other hand, Surbhi defines confidentiality as a state when it is intended or expected ethico-moral and legal boundaries within which nurses must function vis- a- vis protecting the
from someone to keep the information secret. The term confidentiality extracted from the word patient's rights to: respect of human dignity; anonymity, privacy, and confidentiality of health
'confidence' which means "trust." In this way, confidentiality is when it is entrusted that the information.
information which is told in confidence to someone, will be kept secret from the reach of
unauthorized people until the parties agree to uncover the information. Nurses must understand the ethico-moral and legal implications of nursing to be able to
determine what is good or valuable for all people and to judge what is right and wrong.
In Medical, Legal, and other professions, it is common that the information shared between
client and solicitor or doctor and patient, will not be told to the third party. In the military, this
term is scores of times that only authorized officers are allowed to access the confidential
information. It prevents the access of sensitive information from being public.

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 be client advocate.

2. To ensure protection of patients from identity theft, and other improper use of patient
information, specifically for financial gain.

3. To maintain patient's trust. Thus, they will prevent hiding certain facts about themselves.
During this present times of crisis caused by the pandemic COVID 19, the very devastating
effect of patients not being forthright with their history of travels, being exposed to PUIs, PUMs,
having signs and symptoms of "ULAN" (U-bong walang plema; LA-gnats N-ahihirapan sa
paghinga) had caused the untimely, heart- breaking deaths of doctors, nurses, other healthcare
workers and frontliners.

REMEMBER: Open and honest communication between the patient and the health care workers
is of utmost importance for therapeutic relationship.

4. The integrity and availability of the electronic health information will be essential to
physicians and the entire clinical team to be able to trust the data for patient care and decision
making.

5. To prevent unintended consequences detrimental to health research and public health

practice.

6. To ensure availability of accurate health information when needed by the patient.

7. To help maintain a professional attitude in health care settings.

8. To prevent legal suits---thus avoid negative repercussions on the health care institution's'
reputation.

Furthermore, the nurse must understand the law to protect themselves from liability and to
protect their client's rights.

As technology has expanded the role of the nurse, the ethical dilemmas associated with the
client care and health information have increased and often become legal issues as well.
Nurses' familiarity with ethico-moral and legal implications of nursing, enhances their ability to

25 26
 interventions.

CHAPTER 7:
APPLICATIONS OF INFORMATICS IN EVIDENCE-BASED NURSING PRACTICE
The care pathway concept appeared for the first time in 1985 inspired by Karen Zander
LESSON 1: Computer-generated Nursing Care Plans and Critical Pathways
and Kathleen Bower at the New England Medical Center in Boston (Massachusetts,
USA). Care pathways are usually represented as a Gantt chart (Figure 1).
Computer Generated Nursing Care Plans

Nursing care plans or NCPs as we use them in our conversations with our colleagues,
have been introduced to us during our stay in the nursing school. It has been used
extensively inside the academic institution as an essential teaching tool to present the
value of planning patient care, which has been also reinforced by the Joint Commission
on Accreditation for hospitals (JCAH). But in actual clinical settings, it is difficult to find
completely written nursing care plans. If in any case that a written care plan is found,
they can be incomplete, outdated, rarely used for determining care and infrequently relied
upon as a means of communicating problem management from one shift to another. The
nurses view the care plan burdensome, as it Is time-consuming paperwork, preparation
or revision of the plan is low in practice settings (Dharmarajan and Gangadharan, 2013).
It is with this practice that the initiation of a computer-generated nursing care plan was
done. So far, different systematization tools were being used for clinical processes. The oldest
and most known are medical and nursing protocols. Over the last years other tools were
The computer-generated nursing care plans promotes the value of planning care but at introduced, such as clinical practice guidelines and standardized nursing care maps. Care
the same time addresses the burden of the workload NCPs can consume from the nurses. pathways are care protocols that embrace all of these tools (Figure 2).
It works by providing a template that nurses can work on and modify based on the
individual cases of their clients.

CRITICAL PATHWAYS

Critical Pathways

Care pathways are considered to be one of the best tools hospitals can use to manage
the quality in healthcare concerning the standardization of care processes, since they
promote organized and efficient patient care based on evidence. It has been proven
that their implementation reduces the variability in clinical practice and improves The main goal of care pathways is based on the improvement of the following areas:
outcomes. quality in healthcare, coordination / cooperation among professionals, efficiency and
patient satisfaction. Thus, the purpose of pathways is the enhancement of care
Care pathways are also known as Clinical or Critical pathways. A care pathway is a processes in three areas: quality, safety and efficiency.
multidisciplinary healthcare management tool based on healthcare plans for a specific
group of patients with a predictable clinical course, in which the different tasks or Care pathways are a powerful tool for care process management, since they permit to
interventions by the professionals involved in the patient care (physicians, nurses. check the compliance of all the interventions included in the healthcare plan, fix care
pharmacists, physical therapists, social workers etc.) are defined, optimized and standards and introduce clinical audits as a part of the process. Likewise, pathways are
sequenced either by hour (ED) or day (acute care). Outcomes are tied to specific very useful to identify improvement areas in these standardized care processes, under

27 28
the umbrella of Continuous Quality Improvement (CQI). pathway, then the health care costs will be controlled. Remember, the clinical pathways
are not final. It always gets revised frequently depending on the institution, as our
The development and implementation of a care pathway involves a change in the healthcare environment is dynamic. Collaboration within all members of the healthcare
organizational culture at any setting. This process may involve overcoming of some team is a must to ensure a smooth and proper implementation of these clinical
hurdles in its way of implementation. Following are some of the activities to be done to pathways.
develop and implement a care pathway:
See the sample documentation for further understanding of these variances.
Preparing multidisciplinary documents
Sample Documentation Using Clinical Pathway
Reviewing the process by all the concerned staff

Holding care pathway meetings to facilitate the exchange of opinions about patient care
by different professionals

Conducting periodic reviews to monitor some defined indicators

Analyzing variances or deviations

Preparing common record documents for all the staff

Some barriers in developing and implementing a pathway are identified: the

heterogeneity of patients and diagnosis, the common reluctance among organizations
and professionals to change. Hospital managers must consider these barriers since they
may threaten a successful implementation of care pathways.

How to document variances? (Institutional guidelines may apply and not

strictly confined to the guidelines below)

1. Similar to DAR (Data, Action, and Response) format, we utilize VAO (Variance,
Action, and Outcome) to document variances.

2. Variance - includes all subjective and objective data observed by the nurse to be
outside of the pathway management of the patient's case.

3. Action - includes all interventions used to address the variance

LESSON 2: Clinical Guidelines
4. Outcome - includes all patient care outcomes after the interventions were performed
to address the variance. Clinical Guidelines

Important Note: Variances are not something to be taken negatively. It may increase Clinical practice guidelines are statements that include recommendations intended to
healthcare costs due to the management of these variances that are outside of the optimize patient care. They are informed by a systematic review of evidence, and an
clinical pathway, but over time as these variances become common and established a assessment of the benefits and harms of alternative care options. CPGs should follow a
pattern, then it can be included in the clinical pathway depending on the institution's sound, transparent methodology to translate best evidence into clinical practice for
approval and analysis of the situation. If sooner or later it becomes part of the clinical

29 30
improved patient outcomes. Additionally, evidence-based CPGs are a key aspect of What is it? Systematically Structured, A suggested course of
patient-centered care. developed statements multidisciplinary plans treatment and/or
to assist practitioners of care. treatment service for a
Clinical practice guidelines should be developed using rigorous evidence-based and patient make specific diagnosis,
decisions about functional deficit or
methodology with the strength of evidence for each guideline explicitly stated.
appropriate health care problem area.
• Clinical practice guidelines should be feasible, measurable, and achievable.
What does it Makes specific Supports the Highlights major
• Clinical performance measures may be developed from clinical practice guidelines do? recommendations on implementation of therapeutic
and used in quality improvement initiatives. When these performance measures health care and links clinical guidelines and intervention points.
are incorporated into public reporting, accountability, or pay for performance these to research protocols. Identifies choices of
programs, the strength of evidence and magnitude of benefit should be sufficient evidence. difference courses or
to justify the burden of implementation. paths of treatment.
• In the clinical setting, implementation of clinical practice guidelines should be Suggests other
prioritized to those that have the strongest supporting evidence, and the most diagnosis that could be
impact on patient population morbidity and mortality. considered as
• Research should be conducted on how to effectively implement clinical practice treatment progresses.
guidelines, and the impact of their use as quality measures. How does it Provides a summary Provides detailed Provides a logical flow
work? and appraisal of the guidance for each of interventions.
best available research stage in the Provides detailed
evidence or expert management of a recommendations that
consensus. patient. build on those made in
Highlights the strength guidelines.
of the evidence
underlying each
recommendation.
Who uses it? Clinicians/Medical A multidisciplinary Specific
Directors, patients and clinical team. clinicians/Medical
third parties Doctors with
specialization.
Also known Guidelines Integrated Care Protocol
as… Clinical Practice Pathways Best Practice
Guidelines Multidisciplinary Treatment Protocol
Pathways of Care
Pathways of Care
Care Maps
Collaborative Care
Pathways
What are its 1) Appraisal of 1) Timeline 1) List of major
components? literature research 2) Categories of therapeutic
evidence or expert care/interventions interventions
consensus) 3) Intermediate and 2) Goals: When
2) Summary of long term outcome interventions should be
recommendations. criteria achieved
3) An outline of how 4) A variance record 3) Options for different
The differences between Critical Pathway and Clinical Guidelines (Kumar, 2020)
guideline should be choices of treatment
Clinical Guideline Clinical Pathway Practice Protocol implemented and how 4) Differential
Focuses on Specific Clinical The quality and co- Treatment adherence monitored. diagnoses and
Circumstances ordination of care treatments based on

31 32
 the achievement of
these goals
Clinical Care Classification (CCC) System

• It was developed from a research study conducted by Dr. Virginia K Saba and a
research team through a contract with Health care Financing Agency (HCFA),
currently known as the Centers for Medicare and Medicaid Services (CMS)
E-JOURNALS • A standardized, coded nursing terminology that identifies the discrete elements
of nursing practice.
E-Journals • The CCC provides a unique framework and coding structure.
• It is used for documenting the plan of care; following the nursing process in all
E-Journals or electronic journals are scholarly publications in digital form, which are health care settings.
accessible on the web. In the Philippines, we have the Philippine E-journals • Specifically designed for clinical information systems, the CCC facilitates nursing
([Link]) where you can find an online bibliographic database & repository of documentation at the point-of-care.
academic journals in different disciplines various resources. These are often used as • The CCC was developed empirically through the examination
acceptable review of related literatures for research projects and evidence-based of approximately:
nursing practice. (See Unit 8- Informatics application in Research for the reliable search
engines that you can use for research) -40,000 textual phrases representing nursing diagnoses/patient problems,

-72,000 phrases depicting patient care services and/or actions.

• The use of the CCC has expanded into other settings, and it is claimed to
CHAPTER 8: CLINICAL CARE CLASSIFICATION SYSTEMCHAPTER 8: CLINICAL CARE be appropriate for multidisciplinary documentation.
CLASSIFICATION SYSTEM • It is an American Nurses Association (ANA)-recognized comprehensive, coded,
nursing terminology standard. In 2007, the CCC was accepted by
the Department of Health and Human Services as the first national
nursing terminology.
• The computable structure of the CCC System allows nurses, allied
health professionals, and researchers to determine; care needs
(resources), workload (productivity), and outcomes (quality).

The CCC (capturing the essence of patient care) consists of two interrelated
terminologies:

-the CCC of Nursing Diagnoses & Outcomes

-the CCC of Nursing Interventions & and Actions
(Classified by 21 Care Components that link the two together. This merge enables a
roadmap to other health-related classification systems.)

History

1988 to 1990, Harriet Werley

33 34
•Established the Nursing Minimum Data Set, which consisted of 12 variables: 8 2020, HCA Healthcare
variables focused on patient demographics and the remaining 4 focused on nursing
practice. These were: •Became the new custodian of Dr. Virginia Saba’s Clinical Care Classification (CCC)
System.
(a)nursing diagnoses,
(b)nursing interventions, Major features
(c)nursing outcomes, and
• Consists of discrete atomic-level concepts using qualifiers to enhance and
(d)nursing intensity. expand the concepts.
• Data are collected once and used many times for many purposes including
•The Nursing Minimum Data Set became the basis for the nursing classification efficient aggregation.
standards recognized by the ANA. • Copyrighted and in the public domain; available with permission without any
1991, the Database Steering Committee cost or license.
• Specifically designed for electronic health records (EHRs) and healthcare
•Submitted to the Congress on Nursing Practice a resolution that NI be adopted as a information technology (HIT) systems as well as other electronic information
processing systems.
new nursing specialty. This submission which was accepted, leading to the
• Tested and applicable in ALL healthcare settings.
development of the Nursing Informatics: Scope and Standards of Practice and the
• Conforms to Cimino (1998) criteria for a standardized healthcare
certification of NI specialists.
terminology. Coded standardized framework for electronic documentation,
1992, the Database Steering Committee retrieval, and analysis.
• Codes based on ICD-10 (WHO, 1992) structure for information exchange
•Developed the criteria, recognizing the first 4 of 12 promoting interoperability.
nursing classifications/terminologies. One being the CCC System. Previously known as • Uses a coding structure of five alphanumeric digits to link the two CCC System
the Home Health Care Classification System, as nursing standards for the terminologies to each other and to map to other EHR/HIT systems.
• Designed for determining workload (productivity), resources (needs), outcomes
documentation of nursing practice using computer technology systems.
(quality), and care costs.
•The ANA subsequently submitted the four of six classifications/terminologies to the • Concept terminology with online source files so public and private organizations
National Library of Medicine for input into its developing Unified Medical Language may harmonize nursing information formats for cross-organizational sharing of
System’s (UMLS) Metathesaurus. information.
• Facilitates the electronic documentation of patient care at the point of care.
2006, President George W. Bush • Uses a framework of care components to classify the two CCC System
terminologies and represent 4 healthcare patterns focusing on a holistic
•Issued an Executive Order (No. 13410) that every person in the country should have approach to patient care.
an EHR by 2014. • Consists of flexible, adaptable, and expandable concepts/data elements.
2007/2008, the Healthcare Information Technology Standards Panel
The CCC Model
•selected and recommended the Clinical Care Classification (CCC) System as the first
• Depicts the documentation of patient care by nurses and allied health providers
national nursing terminology inter operable for the exchange of information among in any health care setting as an interactive, interrelated, and continuous
HIT systems. feedback process.
•The CCC System was one of the standards in the first set of 55 national standards • The CCC Model illustrates the relationship between the CCC of
approved for use in the EHR, by the Department of Health and Human Services (AHIC, Nursing Diagnoses and Outcomes and the CCC of Nursing Interventions
and Actions. The arrows are bi-directional indicating the continual flow
2006) and the only national nursing terminology standard.
and feedback among the three major concepts:

35 36
□Nursing Diagnoses The Actual Outcomes represent whether the goals were met or not met using the
qualifiers in the past tense as:
□Interventions -Improved,
□Outcomes. -Stabilized,
-Deteriorated

System framework
CCC CODING
Components:
A nursing care component is defined as a cluster of elements that represents a unique • First position: One alphabetic character code for Care Component (A to U);
pattern of clinical care nursing practice; namely: Health Behavioral, Functional, • Second and Third positions: Two-digit code for a Core Concept (major category)
Physiological, and Psychological. followed by a decimal point;
• Fourth position: One-digit code for a subcategory, if available, followed by a
Nursing Diagnoses: decimal point;
A clinical judgment about the healthcare consumer’s response to actual or potential • Fifth position: One-digit code for: one of three Expected or Actual Outcomes and
health conditions or needs. The diagnosis provides the basis for determination of a plan /or; one of four Nursing Intervention Action Types
to achieve expected outcomes. Registered nurses utilize nursing and medical diagnoses
depending upon education and clinical preparation and legal authority”
The CCC: additional
Nursing Interventions:
A nursing intervention is defined as a single nursing action – treatment, procedure or
• The significance of the CCC is a nursing terminology that completes the missing
activity
link needed to address nursing contribution to healthcare quality. Nursing care
–designed to achieve an outcome to a diagnosis, nursing or medical, for which the
may be the most critical factor in a patient’s treatment and recovery. The
nurse is accountable.
partnership of nursing and technology is vital for designing nursing practice
environments.
Patient services are usually initiated as medical orders by a referring physician and
• The benefit of the CCC is the ability to represent the essence of nursing care in
reviewed by the admitting nurse. As part of the admission assessment the primary
health information systems and applications during any patient care, transfer or
nurse also determines the nursing orders based on the signs and symptoms,
transition.
diagnoses, and expected outcomes/goals; and together, form the plan of care that
• The CCC supports the mandate of accrediting organizations to reconcile patient-
requires the nursing interventions following the nursing process.
centered information (The Joint Commission, 2011) ([Link]
[Link]) and supports the informational exchange and data integrity
requirements of CMS and the Office of the National Coordinator (ONC) for
meaningful use when patient data is exchanged by using the Nurse
Process recognized for professional nursing.
Nursing Outcomes:
• Standardized professional documentation
• Standardized data on nursing interventions for evidence-based practice and
The CCC of Nursing Outcomes Version 2.5 consists of 528 concepts derived from the
research Re-usable health data for cross-organization exchange comparisons
three qualifiers used to modify the 176 Nursing Diagnoses: Improve(d), Stabilize(d), or
• Documented outcomes by nursing diagnoses
Deteriorate(d). These three qualifiers depict the Expected Outcomes and Actual
• Standardized quality outcomes comparisons by nursing intervention and action
Outcomes –totaling 528 nursing outcome concepts.
type
The Expected Outcomes represent the goal of patientcare in future tense as will:
Applied uses
-Improve, resolve patient's condition
-Stabilize, maintain patient's condition Nursing Practice Applications:
-Deteriorate

37 38
 • Capture patient care data using a standardized coded nursing terminology. Code Outcomes Types
electronic clinical encounters: diagnoses, interventions, and outcomes. Track To improve Improved (.1) Assess or
nurses’ contribution to patient care and care outcomes. (.1) Monitor
• Provide standardized concepts (data/elements) for clinical pathways and (.1)
decision support. To stabilize Stabilized (.2) Perform or
• Enable evidence-based practice protocols to process and analyze patient care Nursing (.2) Care (.2)
data and to evaluate the effects of nursing care on patient outcomes. Diagnosis + Deterioration Deteriorated Teach or
(.3) (.3) Instruct + Nursing
Nursing Education Applications: (.3) Intervention
Manage or
• Teach students how to electronically document and code POCs based on the Refer (.4)
nursing process. Track student assignments: procedures and protocols. Example: Expected Outcome Activity Intolerance----- To improve ----- A01.0.1
• Test and evaluate online the clinical documentation of student’s patient
care. Teach and evaluate student use of simulations. Example: Actual Outcome Activity Intolerance----- Improved ----- A01.0.1
• Use Second Life to enhance educational experiences.
• Use the CCC System application to enhance nursing educational experiences. Example: Intervention Teach Activity Care--- A01.0.3
Nursing Research Applications:

• Search online nursing literature for nursing ontology and the CCC System. Table 2
• Research the use of relative value units and the CCC of Nursing
Interventions/action Types .Analyze and interpret nursing output in the EHR. CARE DIAGNOSES NURSING INTERVENTIONS
• Support research to advance NI science and knowledge. COMPONENTS
A. ACTIVITY (A01.0) A01.1--- Activity Intolerance A01.0--- Activity Care
Nursing Administration Applications:
ACTIVITY (Incapacity to carry out (Activities performed to
• Capture standardized quality indicators and measures.
ALTERATION physiologic or psychological carry out physiological daily
• Capture and measure the impact of care on outcomes.
daily activities) activities)
• Determine and measure nursing workload, resources, and cost. Change in or
• Support the prediction of patient acuity and care needs. modification
or energy
CLINICAL CARE SYSTEM NURSING: CCC CODING used by the A01.2--- Activity Intolerance A01.2--- Energy
body Risk Conservation
CLINICAL CARE SYSTEM NURSING
(Increase chance of an (Actions performed to
CCC CODING
incapacity to carry out preserve energy)
physiologic or psychological
Table 1
daily activities)
CARE NURSING DIAGNOSES and OUTCOMES NURSING A02.0--- Fracture Care
COMPONENTS INTERVENTIONS and
ACTIONS A01.3--- Diversional Activity (Actions performed to
Nx. Diagnosis Expected Actual Action Nursing Deficit control broken bones)
Outcomes Interventions

39 40
(Lack of interest or (Actions performed to
engagement in leisure assist in moving from one
activities) A02.1--- Cast Care place to another)

(Actions performed to
control a rigid dressing)
A01.4--- Fatigue A04.0--- Sleep Pattern
Control
(Exhaustion that interferes
with physical and mental A02.2--- Immobilizer Care (Actions performed to
activities) support the sleep and wake
(Actions performed to cycle)
control a splint, cast. or
prescribed bed rest)
A01.5--- Physical Mobility
Impairment A05.0--- Musculoskeletal
Care
(Diminished ability to A03.0--- Mobility Therapy
perform independent (Actions performed to
movement) (Actions performed to restore physical
advise and instruct mobility functioning)
deficits)

A01.6--- Sleep Disturbance

A05.1--- Range of Motion
(Imbalance in the normal A03.1--- Ambulation
sleep/ wake cycle) Therapy (Actions performed to
provide active and passive
(Actions performed to exercises to maintain joint
promote walking functioning)
A01.7--- Sleep Deprivation

(Lack of a normal sleep/

wake cycle A03.2--- Assistive Device A05.2--- Rehabilitation
Therapy Exercise

(Actions performed to (Actions performed to

support the use of products promote physical
to aid in caring for oneself) functioning)

A03.3--- Transfer Care A06.0--- Bedbound Care

41 42
 • Nurses must be able to manage and process nursing data, information, and knowledge
to support patient care delivery in diverse care delivery settings (Graves & Corcoran,
1989).

PLAN OF CARE • There is an essential linkage among access to information, client outcomes and patient
safety. “As Lang has succinctly and aptly described the present situation: If we cannot
Table 3: Example of the CCC Systems’ Coding Structure for a Nursing PoC name it, we cannot control it, finance it, teach it, research it or put it into
public policy” (Clark & Lang N., 1992).
Assessment Activity Component: (A)
Nursing Diagnosis Physical Mobility Impairment: (A01.5)
Expected Outcome: Patient’s Condition (will) Improve: (A01.5.1)
Planning: (provide 2 Core Ambulation Therapy: (A03.1)
Intervention) Rehabilitation Exercise: (A05.0)
Nursing Intervention: Teach Ambulation Therapy: (A03.1.3)
Nursing Intervention: Perform Rehabilitation Exercise: (A05.0.2)
Actual Outcome: Patient’s Condition (has) Improved : (A01.5.1)

*Aside from CCC coding, health practitioners and providers also use ICD10 codes for
diseases and CPT codes for procedures and HCPC for other services and supplies and
equipment. You may refer to related websites in the internet such as:
[Link]

CHAPTER 9:
NURSING INFORMATICS ON INTERNATIONAL PERSPECTIVES

Lesson 1: Nursing Informatics in Canada

NURSING INFORMATICS IN CANADA

A coordinated system to collect, store and retrieve nursing data in Canada is essential for
health human resource planning and to expand knowledge and research on determinants of
quality nursing care… CNA believes that registered nurses should advocate and lead in
implementing the collection, storage and retrieval of nursing data at the national level.”
(Canadian Nurses Association 2001)

• The Canadian Nurses Association (CNA) has taken the position that “registered nurses
and other stakeholders in healthcare delivery require information on nursing practice
and it relationship to client outcomes.

43 44
 The Canadian Advisory Council (CAC) on Informatics Health (Z295) advises the
Canadian Stands Association (CSA).

Canadian Organization for the Advancement of Computers in Health or COACH

- founded in 1975, has actively initiated professional protocols for using computer
systems in Canadian health care.

• Focus of NI in Canada is the role of nursing within healthcare organization. In most HC

organizations, nurses manage both patient care and patient care units within
organization. Usually nurse clinicians manage patient care and nurse managers
administer the patient care units within the organization. Therefore, for
some time, nursing’s role in the management of information has been considered
to include both the information necessary to manage patient
care using nursing process and the information necessary for managing patient
care units within the organization.

Canadian Institute for Health Information

• The establishment of the National Health Information Council in the late 1980’s lead to
the National Task Force on Health Information, also known as the Wilk Task Force,
which presented comprehensive goals and a strong vision for a nationwide health
information system.
• CIHI is an independent, national, not for profit organization, established jointly by
federal and provincial/ territorial ministers of health.

• During the decade of its existence CIHI has become an acknowledged and trusted
source of quality, reliable and timely aggregated health information for use in The Canadian Nursing Informatics Association
understanding and improving the management of the Canadian health systems and the
health of the population of Canada. In 2001, a new group, the Canadian Nursing Informatics Association (CNIA)
received emerging group status from the CNA and affiliate status in 2003. The CNIA
• Standards Council of Canada now has full associate status with the CNA.

45 46
The mission of the CNIA is to be the voice for Nursing Informatics In Canada nurses are in the fortunate position of recognizing the need for nursing data
in Canada. Recognizing the importance of the work the CNIA is undertaking, the elements at the time when the national health infrastructure is under development. To
Canadian Nurses Association has granted associate group status to the CNIA. prevent nurses in Canada from losing control of nursing data, nurses must take
a proactive stance and mobilize resources to ensure the development and
implementation of a national health data base and a pan- Canadian EHR that is congruent
The Canadian Nurses Portal Project, NurseONE, E-Nursing Strategy with the needs of nurses in all practice settings in Canada.

In 2006, the Canadian Nurses Association launched the Canadian Nurses Portal
Project, shortened to NurseONE to address this vision, in the form of a e-nursing Lesson 2: Nursing Informatics in Asia
strategy.
Since computers were first introduced into the health into the healthcare sectors of Asian
“The purpose of the e- nursing strategy is to guide the development of ICT initiatives in countries in the 1970's. there have been exciting developments in healthcare informatics
nursing to improve nursing practice and client outcomes” (Canadian Nurses associated with the rapid growth in information and communication technology. The first
Association, 2006, p. 7). applications of information technology in healthcare in Asian countries were in
administration billing and insurance. Now these countries are moving toward
OBSTACLES TO EFFECTIVE NURSING MANAGEMENT OF INFORMATION IN CANADA implementing paperless electronic health records.
NI have varied between Asian countries, but all governments have played a very
[Link] Canadian health care delivery organizations, like hospitals and health care agencies important role in introducing information technology into the healthcare sector by
in other countries, the major obstacles to more effective nursing management of providing funds, developing infrastructure and introducing policies to promote its use.
information are: Professional organization have also played an important role.
The adoption of informatics in Asian countries usually began as a vision by a group of
-the sheer volume of information, individuals in the government or a professional organization, who promoted the use of
-the lack of access to modern information handling techniques and equipment,
information technologies to support nurses in all areas of nursing practice.
As information technology has become indispensable to daily activities of healthcare
-and the inadequate information management infrastructure. professionals. more and more nursing schools are beginning to realize the importance of
providing informatics courses to nurses.
2. Antiquated manual information systems and outdated information transfer facilities
Basic computer literacy education is now a part of nursing education in most Asian
are information redundant and labor intensive to say nothing of an inappropriate use of
countries, and graduate programs majoring in NI are also available now in some
an expensive human resource, that is to say nursing time and energy.
countries, such as south Korea and Taiwan.
Reports of research into NI began to appear in the domestic Asian nursing journals in
3. Software and hardware for modern electronic communication networks are only two
1990's, but such research is still in its infancy. In most countries, information technology
aspects of an information infrastructure. The other major aspect is lacking in most
first appeared as an educational tool, following by its use in clinical practice in applications
hospitals and health services organizations, that is, the absence of appropriate
such expert systems and electronic nursing records. This use in clinical practice lead to
infrastructure to facilitate information management. Infrastructure includes but is
the development of standards becoming a favorite research topic.
not limited to:
Events external to the nursing profession catalyzed the adoption of informatics links have
assisted these begining and their progression. The progress in japan, China, and South
-data management policies and procedures,
Korea has been expedited by the hosting of the International Medical Informatics
-methods for data stewardship and custodianship, Association (IMIA) triannual conference in 1980, 1989, and 1997 respectively.
the formation of the Asia Pacific Medical Informatics Association in 1993 helped launch
-user training and information management support staff. Support staffs are necessary to
national healthcare informatics association in China, Japan, South Korea, and Thailand
support nurses in appropriately analyzing and interpreting aggregated information.
due to the hosting of triannual conferences in the Pacific Rim. The China, Japan, and
CANADIAN INITIATIVES DIRECTED AT THE DEVELOPMENT OF NURSING Korea Medical Informatics Association (formed in 1999) organizes conferences, seminars
COMPONENTS OF HEALTH INFORMATION (HI:NC) and workshops once a year and creates forums by for the sharing of experience and

47 48
knowledge among both experts and users in these three countries. Asian nurses who are care when clinicians began to use computers in their practice. A recent study shows that
interested in promoting Informatics to their profession need to link out with this network. all of the teaching hospitals and about 40% of general hospitals in Korea are using order
Communication systems (Kwak 2000), which enable physicians to communicate with
other departments for practiced -related requisitions and the retrieval of data. In addition,
NURSING INFORMATICS IN KOREA about 95% of teaching hospitals and 20% of general hospitals are equipped with pictures
archiving and communication system(PACS's). There has been a great deal of interests
South Korea compress eight provinces with seven metropolitan cities and the total among healthcare organizations in acquiring the system since the government announced
population was about 47 million in 2002. high reimbursement rates for diagnostic radiology examinations using PACS in 2000, and
PACS are now one of the most common information technology systems in South Korea
The population is predominantly in urban areas, with 21% living within the Seoul
hospitals. Hospitals in South Korea are now beginning to implement paperless electronic
metropolitan area.
medical record systems.
There are currently 190,720 licensed midwives and nurses of whom 81,478 are
The use of computers in clinical nursing practice in Korea began first in medium-sized
practicing and 23,331 of these are situation the Seoul metropolitan area. Health
hospitals. These hospitals initially used computers mainly for administration and billing,
Informatics in South Korea has growth considerably in recent years professional
as did most hospitals in other countries, but later a patient-care component was added.
outreach activities.
These systems allowed physician to enter medical orders directly into the computers, and
In the contrast, computers were not used in nursing education and research in 1993
major ancillary department could receive requisitions and enter test results. The nurses
and NI was not taught in universities until 1994. In 1993, The Nursing Informatics,
work list could be viewed on screen or printed so that the nurses did not need to copy
special interest group was organized in the KOSMI, since the nursing informatics group
medication schedules or care activities into the cardex or write paper messages.
has held its own session at the biannual conferences of the KOSMI.
Other Korean hospitals were also pursuing this level of automation. Nursing information
system proliferated when large hospitals ( with more than 1000 beds) began opening in
Nursing has been highly visible in the KOSMI by the presentation and publishing of
the mid-1990's. These new hospitals were equipped with nursing information systems
papers on the used of computers in nursing of these conferences and in the journal of
when they first opened. They included unique nursing activities such as nursing
the KOSMI.
assessments, nursing care plans, and patient classifications, in addition to nursing
the IMIA conference MIDINFO98, held in Seoul provided an excellent opportunity for
activities related to billing, managerial and coordinating activities and physician delegated
Korean nurses to become acquainted by NI.
tasks.
Currently there are modern 200 active nurse members in the KOSMI of 1000 active
A home healthcare system for community-based clinical practiced was developed by the
members.
Home Healthcare Team at the College of Nursing, Seoul National University (Park et
Further momentum for NI has been coming from funding for a NI study group provided
al.,2000).Home healthcare nurses use laptop computers to note and check medication
by the Korean science and engineering foundation since 1998.
and progress in electronic patient records,and to communicate electronically with other
Activities of the study group include journal reviews and research activities such as
home healthcare team members.
survey studies of NI education and computer applications in nursing practice in Korean
hospitals.
Health Information Education
Korean nurses have attended and participated in many international conferences
promoted or supported by IMIA or IMIA-NI group since 1989. As information technology has become indispensable in healthcare and its impact on the
Korean Nurses represented the country at the IMIA-NI group of 1995, since then Korea daily activities of healthcare professionals has become significant, schools are beginning
has sent a representative to the group and participated actively in developing and to realize the importance of health informatics education for clinicians. According to the
furthering NI. recent surveys on health informatics and computer education programs in South Korean
medical and nursing schools, about 25% of medical schools and 21% of nursing schools
Use of Information Technology in Clinical Practice offer health informatics courses, while the remainder offer introductory computer courses
(Park, 2002). The course contents vary a great deal from school to school, and the
According to the report published by the Korea Health Industry Development Institute in
instructors are mostly self-taught in these subjects. This indicates that there is a a need
2000,100% of teaching hospitals, and 75% of private clinics now have hospital
for standardization of health informatics courses for baccalaureate programs based on
information systems (Korea Health Industry Development Institute,2000). Such a high
tasks of healthcare professionals, together with graduate programs to produce qualified
implementation rate is believed to have been initially driven by financial factors associated
health informatics educators.
with medical insurance claims, with the focus subsequently shifting to all areas of patient

49 50
Most nursing schools in Korea are adding informatics to graduate curricula so that
graduate students can take informatics courses as an elective. The graduate specialization Government Initiatives
program in NI in Korea was first introduced at Seoul National University in 2001. This
The Korean government has contributed to the development of health informatics by
program is the only one in Korea that awards a master's degree in NI.
providing funding or other incentives and guidelines in telemedicine, emergency medical
systems, infectious diseases reporting systems, and standardization. The Korean
Research
government has contributed to the implementation of a nationwide information highway,
Most papers presented at KOSMI conferences and published in the Journal of the KOSMI with the Ministry of Information and Communication having funded information, highway
since 1991 have addressed the application of commercially available programs, with more projects since the early 1990's. There are two information highways available;(1) the
recent papers discussing the use of computers as the total for nursing education. Distance South Korea Advanced Research Network, which is mainly used for research activities
education using the Internet has also been described (Park, Cho and Kim,1998;Cho and (2) a nationwide commercialized network built by telecommunication companies
and Park,1998; Kim et al.,2000; Choi et al.,199. The trend toward system integration in (Korea Ministry of Information and communication,2002). These network interconnect 12
the health industry in the late 1990's lead to more articles and presentations on metropolitan areas in South Korea at 622 Mbps and smaller surrounding cities are
standardization. Papers on the standardization of nursing vocabulary and nursing connected at 155 mbps. Individual users at their home can use ADSL (asynchronous
documentation forms have also appeared (Park et al., 1999; Park and Cho, 2000; Coenen digital subscriber line) to connect to the Internet at a speed of 1-8 Mbps, and currently
et al.,2001). more than 50% of South Korean homes have ADSL connections. This is highest
Another popular research area is the use of artificial intelligence in nursing diagnosis percentage among all countries of the world.
(Park, Lee and Song,1995; Kim 1998; Yoo et al.,1998). The use of personalized digital The Korean Ministry of Health and Welfare established a long-term plan for national
assistants (PDAs) in hospital and home health-care settings along with the health and welfare network (NHWN)in 1993. The NHWN cover six areas; public health,
standardization and the use of Web-based electronic patient records and current areas hospitals and clinics, health insurance, food and drugs, national pension, and health and
of interest (Hyun et al.,1999, Cho and Park ,2003). welfare administration. Public health was selected as the top-priority project in 1994, to
be carried out in the three phases;
Standardization Activities
The first phase (form 1994-1997) computerized the administrative and patient-care
There are current efforts to implement a single, integrated healthcare and nursing activities of health centers.
terminology in South Korea, the primary motivation for which is compatibility of data, The second phase (from 1998-2001) developed infrastructure for the public health
clinical documentation, and research outcomes across the country. There are Korean network, integrating network systems among health centers, health subcenters, and
representatives actively involved in international initiatives toward this end, such as primary healthcare posts. An electronic data interchange system between the public
International Organization for Standardization/ Technical Committee 215 (ISO/TC215) healthcare facilities and the health insurers was developed for health insurance claims.
and Health Level Seven (HL7). Possible ways of linking the NHWN to the city, country, and district networks of the
Administrative information systems in the healthcare sector essentially use the Koren Ministry of Governmental Affairs and Home Affairs were studied.
Standard Classification of Diseases (the Korean version of the International Classification The current third phase, which started in 2001, involves the development of data
for Disease [ICD]10), while clinician information systems are beginning to use more warehousing at the level of major cities and provinces. Once this system is implemented
concept -oriented terminology such as the SNOMED (Systematized Nomenclature of successfully, it will be expanded to the whole of South Korea.
Medicine). The majority of existing nursing terminologies, such as the North American
Nursing Diagnosis Association (NANDA) Taxonomy 1 and 2, Nursing Interventions Professional Outreach
Classifications (NIC), Home Healthcare Classification (HHCC), the Omaha system, Nursing
Outcomes Classification (NOC), and International Classification for Nursing Practice Since its foundation in1987, the KOSMI has played a very important role in promoting
(NCP), have been translated into Korean and standardized. Among these terminologies, and developing health informatics by holding biannual academic conferences, various
the NANDA is the most frequently used in nursing education, and the 3N (NANDA, NIC- seminars , workshops, and open forums, and by publishing journals. KOSMI has also
NOC) and INCP are most frequently used in clinical practice for electronic nursing record offered educational programs for beginners in health informatics.
systems in Korea. Organization such as the Korean medical Association and the Korean Nurses Association
have also played a significant role by including health informatics in their continuing
education programs. Another healthcare informatics expert group, the Health Informatics

51 52
Standardization Committee, serving as the South Korean technical advisory group of the pays the rest when a patient receives medical treatment in a hospital. The hospital
ISO/TC215, has held open forums and published health information standards. receives reimbursement for the balance from the national health insurance. The
The IMIA has contributed significantly to furthering the knowledge of South Korean Japanese government will contribute a maximum of 70,000 yen to the medical
healthcare professionals about worldwide trends in health informatics. These individuals treatment of a person over 1 month. Both the easy access to healthcare and low out-of-
have attended and participated in many international conferences promoted or supported pocket cost in japan to help to provide the populace with a sense of security.
by the IMIA since 1989.
History of Nursing Informatics in Japan
Technology Trends
The Third International Congress on Medical Informatics, MEDINFO 80, organized by the
IMIA, was held in Tokyo in [Link] congress included a special group on NI, which
The rapid growth in the number of mobile telephone users (currently estimated to be
represented the beginning of NI in Japan (JAMI, 1996; Kamiizumi and Ota 2004). This
around 65% of the total population) and the advance in wireless local area network (LAN)
did not result in immediate progress in Japanese NI education, due to schools being
technology have led to mobile computing in healthcare becoming a popular issue in South
vocationally oriented. However, in the late 1990's nursing education in Japan rapidly
Korea, with many healthcare organizations testing its feasibility in special wards. The
shifted to more academic orientation, and there are now more than 100 universities
main users of the systems currently are nurses attending patients at bedsides, but this
offering graduate programs. Some baccalaureate programs and graduate schools include
will soon be extended to other healthcare professionals. Although PDAs, Web pads, and
NI courses in their curricula. NI was applied more in clinical practice than in academic
notebook and tablet computers are all suitable mobile computing platforms, users favor
fields during the 1990's, with more nurses learning about utilizing computers in nursing
notebook computers with wireless LAN connections because of their larger screen size
practice through the activities of medical information department setting in the national
and easier-to-use interface.
university hospitals. It was also evident that clinical nurses presented more papers than
The need for telemedicine continues to grow in Korea with the increasing numbers of
academic researchers at the annual meeting of the JAMI. The annual Meeting for Nursing
elderly, patients with chronic diseases, and patients who are discharged early. Many
Information Systems that was established as a task force of the JAMI also supports clinical
telemedicine systems have been tested over the past 10 years, one of which is a
practice, and most of its members are clinical nurses. The nursing Division of the JAMI
teleconsultation system initiated by the government. Such systems allow, for example, a
was established in 2000 and is managed by a team of clinical nurses and academic
generalist doctor at a healthcare center in a remote area to have a telepathology
researchers. Several textbooks on NI have been published, but systematized NI education
consultation with the specialists of a tertiary hospital. Another example of telemedicine is
has not yet been implemented. The Japanese Nurses Association prepared a course of
telecare at home at home, with the telecare center of Seoul National University Hospital
nursing information management first step of a continuing education curriculum for ward
and the telemedicine center of Gil Hospital being among the most active telecare at-home
managers. The standard textbooks were published on March 2004, and the lectures are
clinics (Yoo,2002). Telepractioners at these centers maintain special schedules for their
researchers of health informatics and NI, and clinical nurses working at the hospital where
remote clients. They set aside 1-2 days per week to take care of their clients using virtual
hospital information systems were introduced.
reality technology via the Internet. Currently, the teleconsultation fee is reimbursed by
health insurance, whereas the use of telecare-at-home clinics is not yet covered.
Nursing Informatics Education

As on April, there were 486 professionals schools, 31 junior colleges, 120 universities and
NURSING INFORMATICS IN JAPAN
45 graduate schools in Japan (Tokyo Academy,2004), compared to 461 professional
schools74 colleges ,and 30 universities in 1994(Japanese Nursing Association 2002).This
The population of is about 127 million, which is about twice of the unit kingdom and
comparison illustrates that nursing education in Japan has shifted from professional
half that of the united states. there are about 10,000 hospitals in japan, of which about
schools to universities and postgraduate education during the last 10 years. However,
430 have more than 400 beds. about 750,000 nurses work at these hospitals, including
there are still very few universities with separate NI programs. The increasing
220,000 nurse aides and there about 260,000 medical doctors, 90,000 dentist and
development of hospitals information systems in Japan has led to discussions on the
23,000 pharmacists (Ministry of Health, Labor and Welfare, 2004). The healthcare
utilization of information technology in clinical nursing practice. continuous education of
delivery system in japan provides easy access to healthcare. all citizens can choose
NI is being emphasized, along with the promotion of the electronic records. However, it
healthcare institutions and doctors freely, and their financial contribution to health
is difficult to conclude that the curricula of nursing schools have reflected the changes in
insurance is proportional to their income. The insurance fee is deducted from monthly
the society and clinical fields. Rather, it appears that clinical practice is now more
salary and pooled by each insurance union. Insured individuals and families pay 20 and
advanced than nursing education.
30%, respectively of all health expenditure and the publicly funded health insurance

53 54
Universities provided elementary computer literacy education during the first half of information technologist. Informatics nurses will be expected to expand their activities in
1990's but this become unnecessary thereafter due to introduction of computer education healthcare when both professions are introduced in hospitals.
into elementary and junior high schools. Overall, the teaching of computer literacy on
document retrieval utilization of statistical processing, and Web utilization has increased, Japanese Government Initiatives and Standards Development in Japan
but barriers to the development of the NI remain in Japan:
(1) there are few researchers and educators in NI, An "e-Japan strategy encompassing all Japanese ministries are related agencies in
(2) there is little development of educational tools, and progressing now in Japan. The standardization of medical information is one of the main
(3) the cost of improving the network and computer environment is high themes in the healthcare sector. The Ministry of Health Labor,and Welfare announced a
grand design for healthcare, and set the following achievement goals for 2006( Panel on
However, the importance of universities providing a satisfactory curriculum is being Healthcare and Medical Information Systems;2002):
recognized due to the increasing importance of NI, with this being more so in graduate - Electronic health records will be introduced into 60% of hospitals with more than
schools than in baccalaureate education. 400 beds and into 60% clinics and the electronic health expenditure payment
system will be introduced into 70% of all hospitals,
Nursing Informatics Research - Standardization of the terminology used in electronic health records is a
requirement for achieving this goal, and
The main amount of NI research is increasing in Japan, the two main purposes of which - Ministry of Health, Labor, and Welfare has begun a project for developing a
are improving, the quality and standardization of nursing practice. national standard, which is publicly available on the Internet (The Medical
NI was one of the main subject areas of paper presentation at recent annual meeting of Information Systems Development Center,2004). This is especially useful for
the Japanese Academy of Nursing (Japan Academy for Nursing Science ,2003), indicating hospitals introducing hospital information systems for the first time.
that it was becoming one the major areas in nursing.
There were many reports on research into the use of information technology as an The following 5 standards have already been completed:
educational tool during the 1990's and on the use of information technology o clinical • 581 facilities now perform medical diagnosis using the ICD 10,
practice, especially on decision support system for nursing in hospital information systems • 330 facilities have surgical and medical treatment standards
and electronic health records (JAMI,2003). • 5,700 clinical tests have been registered in the clinical laboratory test standard
There has also been research into the use of information to prevent nursing-related • about 38,000 drug names have been registered by 203 enterprises, and
accidents (Tsuruu et al.,2004) and into telenursing (Kawaguchi,Azuma and Ohta, 2004). • about 210,000 medical supplies have been registered by 336 enterprises.

Nursing Informatics Practice Standardized symptoms, physiologic function examinations, imaging test, dental
terminology, and nursing terminology are currently under development, and nursing
Becoming specialists in NI is useful when hospital information systems and electronic actions and observation items in nursing terminology are available to the public since the
health records are introduced. However, the accreditation program of the Japan Nursing middle of 2004.
Association does not recognize the training for such specialists. Instead, the training of
The terminology used in nursing practice has been collected, analyzed and redesigned.
informatics nurses mainly occurs in hospital setting.
About 260 fundamental nursing practices have been identified and named in Japan. They
In each hospital, nurses working on medical information are active in committees and
have been categorized into daily-life care, family support, guidance and education,
working groups. Most of them involve not only nursing-related work but also medical
adjustment during organization, care in the usage of equipment, care for the terminally
information-related work. Their lack of formal technical education often causes
ill and the bereaved family, and others.
difficulties; hence it is predicted that the importance of nurses with NI education will
The two hospitals were electronic health records using this nursing terminology were
increase.
developed have utilized the terminology describing nursing care plan and nursing order,
The JAMI began an accreditation program for "health care information technologists" in
and in the implementation of care; Continues 24-hour observation of nursing can be
2003.
shared, indicating that the use of such a system is very useful for the medical profession.
hospitals are looking for new healthcare staff with knowledge of both healthcare and
information technology who can control information flow. Although a healthcare
information technologist is a healthcare professional with such training, it is necessary to
distinguish between the roles of the Ni clinical nursing specialist and a healthcare

55 56
NURSING INFORMATICS IN CHINA The first software implementation was a computer assisted primary nursing care system
(Nursing Care Center, Ministry of Health, China 1995).
According to the Fifth National Census reported by the National Bureau of Statistics, the The development of information management system for nursing in Chinese traditional
population of china was almost 1.3 billion in 2000. medicine began in 1994 (Li et al., 2001).
Many hospitals in China now use nursing information systems, although there are no
The population is aging fast, with those 65 years old and older representing 6.96% of
official statistics available, some examples include nursing information system for the
the population in 2000, compared to 5.57% in the 1990 census. There were 17,764
management of nursing staff, nursing operation work, continuing education, scientific
hospitals, 5,275,000 healthcare professionals, and 1,266,000 registered nurses in China
research, and finance and economics (Zhang, Fu, and Fan,1999; nursing information
have baccalaureate and 3-year diplomas, respectively (Nursing School Weizhuo Medical
based on an army satellite project called the no.1 Project of PLA; and and Internet-based
College, 2004).
nursing information management system( Wang et al.,2001;Zhang et al.,2004).
In China, the majority of the population is found in rural areas, and thus the overall
healthcare level, stability of society, and economic development of the whole of China is
History of Nursing Informatics in China
influenced by healthcare services in rural areas.
The primary healthcare systems in rural China typically involved cooperation at country,
Nursing informatics Special Interest Group with 20 hospital nurses was founded as branch
town, and villages levels. These systems include providing medical services, the training
of the CMIA in 1991. A year later an expert group for nursing information technology was
of healthcare staff, hygiene education, and the development of a patriotic health
founded by the nursing Department of the Chinese Ministry of Health, its mission being
campaign (Ma, 2000).
to establish criteria for nursing management and the training for nurse administrators for
The SARS epidemic in China lead to reconsiderations of the current healthcare systems
nursing information management (Nursing Center, Ministry of Health, China 1995).
in rural areas. Some Chinese consider that the system is not moving forward and that
The first article referring to the term "nursing informatics science" appeared in China in
more effort should be devoted to epidemic prevention, and that a new system cooperative
1999, and this led to the application of information technology in the field of nursing
medical care and new salvation system of the poor should be set up to ensure health in
science for education and research (Fan and Fu,2000; Fan and Li, 2000). The term NI
rural areas and enhance stability of society and economic development of country.(
was first used in Chinese literature in 2002 (Jiang,2002).
Zong,2004)
The SARS epidemic also lead to suggestions of an integrated system for disease control
Nursing Informatics Education
and prevention (Lou, Feng and Zhanf,2004).
Higher nursing education was first introduced in 1983,and by 2001 there were 120
This plan includes implementation of National Medical Information Network, advances in schools with 3 year diploma programs,62 schools offering a baccalaureate, and 11
constructing hospitals, information system as well as advances in community healthcare, schools with master's programs( Nursing School of Weizhou Medical College,2004).At
health supervision, disease control, maternal and child healthcare, telemedicine and least one computer course is required at the baccalaureate level , and nursing student
distance medical education (Ministry of Health China,2003). can select other computer courses as elective courses.
According to a literature review , computer-assisted instruction began at nursing institutes
The China Medical Informatics Association (CMIA) was founded in 1981. This is an
in China during the mid-1990's, since then it has been used in baccalaureate and
academic group and is a member. There are 2 other professional societies related to
continuing education courses in the clinical nursing field(Zhu, Lu, and Yin ,1995;Jiang et
medical information in China:
al., 1998; Li et al.,2002).Distance learning is also being used for nursing continuing
• The Chinese society of Medical Information (under the chin medical association)
education in [Link] first distance learning program in China is a collaboration
• The Chinese Hospital Information Management Association (under the Chinese
between China and Canada run by the school of Nursing, (Tian Jin medical university in
hospital association)
1999) Zhou and Song,2001).
The Chinese society of Medical Information was founded in 1993, and its activities include
Nursing Informatics Research
holding academic conferences and seminars, continuing education, and training.
NI research is at its infancy in China, with only 30 research particles published in domestic
nursing journal form 1994-2004 (with the key words related to the use of computers in
Nursing Informatics System in China
nursing and nursing information with the research areas of nursing practice, nursing
management, and nursing education.
The development of nursing information management systems began in China in late
1970’s (Li et al., 2001) and they were first used in 1987 (Nursing Center, Ministry of
Nursing Informatics Practice
Health, China, 1995; Li et al., 1995; Fu, 2000).

57 58
 project was expanded and the development of nursing classification system was later
The used of NI in clinical practice in China includes nursing quality management, staff merged with the project of Nurses Association of Thailand for validating the alpha version
management, nursing information management, and training clinical skills for staff nurses of the INCP developed by the International Council of Nurses (ICN) International Council
(Zhang, Cheng, and Qi,2003). Several expert systems for nursing diagnosis, nursing care of Nurses,1999).
plan, and nursing assessment have been reported (Ji et al.,1994; Wang,1995; Zhang, Fu
and Fan,1999). Nursing Information System

The major weakness of nursing information management systems in China is lack of A further to implement the INCP in the Thai nursing environment was developed, a
national standards and low level of computer literacy and informatics skills exhibited by collaborative software program called "Healthware 2000" by the MOPH Nursing Division
nurses (Nursing Center, Ministry of Health, China,1995). for the collection and retrieval of nursing care data. Several hospitals serve pilot hospitals.
However, the usefulness of the program was limited by it not being sufficiently user
friendly and many nurses having limited knowledge of the ICNP.
NURSING INFORMATICS IN THAILAND The unsuccessful implementation of Healthcare 2000 lead to the MOPH Division of
Nursing further developing standard care plan using the ICNP, which will later be adopted
Thailand is located in Southeast Asia with Burma, Cambodia, Laos, and Malaysia as to computer implementation. This project is still in progress.
neighboring countries. Recently the Nurses Association of Thailand under the leadership of Dr. Jintana Unipan
provided seed money for the development of database including nursing diagnosis,
The country has a population of about 65 million living in 76 provinces. Even though most
nursing interventions, and nursing outcomes, in 10 leading diagnostic-related groups
people work in agriculture, major revenue of the country comes from service and industry
using a version of the beta INCP.
(Economy, 2004). There were 92 regional /general hospitals,707 community hospitals ,
The steering committee for this project comprised nurses from seven specialty areas:
and 9559 health centers across Thailand in 2004 (Country health profile, 2004).
medical nursing, surgical nursing, pediatric nursing, maternal and child nursing, mental
The government is currently launching a universal Healthcare Coverage policy in order to
health and psychiatric nursing, community nursing and home healthcare, and cancer
improve the access to the quality of healthcare, as week as to contain healthcare
nursing.
expenditure. The Thai government is restructuring its healthcare system by placing more
Although the preliminary Thai NMDS has been identified, challenges associated with its
emphasis on primary care and health promotion. Recently the government also attempted
development and implementation within the Thai national health information system
to develop a healthcare for international clients. These policies require changes in human
remain. The evident continuity of the development and implementation within the
resources including nurses, since the demand for nurses in primary care settings across
Thailand demonstrates the commitment of the national nursing organizations.
the country is increasing to serve the population at large, as is that for nurses competent
at working in hospitals serving international clients.
NI was first introduced as small special interest groups and later expanded to the national
NURSING INFORMATICS IN TAIWAN
level through the support of the Nurses' Association of Thailand, the World Health
Organization, and the Ministry of Public Health (MOPH). This section describes the
There was 610 hospitals and 175,000 healthcare professionals in Taiwan in 2002,
development of NI in Thailand between 1997 and 2004.
serving a population of 22,5 million (Health and National Health Insurance Annual
Statistics Information Service in Taiwan, 2004). The healthcare professionals included
The Development of a Health Information System
34.3% registered nurses and 17.7 licensed practicing nurses.
In 1991, the Thai MOPH began to implement a national health information system, which
included the development of a nursing component. The former director of the MOPH History of Nursing Informatics in Taiwan
Nursing Divisions, Mrs. Areeya Suppalak, considered it important to provide nurses with
means of using information technology. Funding was received from the World Health The term NI was first used in Taiwan in [Link] that time the focus was on hospital
Organization in 1999 as a result of collaborative effort between the Center for Nursing information system providing nursing data such as nursing personnel information, care
Research at the Department of Nursing, The faculty of Medicine, Ramathibodi Hospital, planning, and scheduling. However, computers had been used in nursing education since
Mahidol University, and the MOPH Nursing Division to develop the ideal nursing minimum the 1980's and the related nursing research into patient classification supported by the
data set(NMDS) and a preliminary nursing classification system (Phuphibul et al.,1999). National Science Council began in the 1990's (Hsu et al.,1996.) Although a formal
The NMDS was identified as essential for developing and efficient nursing database. The master’s program focusing on NI was not available until 2001, the elective courses in

59 60
baccalaureate and master's program s had started in the late 1990's. All baccalaureate efforts to ultimately benefit the healthcare consumer(our patients),communities ,and
programs included at least one or two computer courses. Currently, some nursing society as a whole.
students act as assistants for faculty in designing distance-learning classes.

Nursing Information System in Taiwan Lesson 3: Nursing Informatics in the Pacific Rim

Based on the unpublished results of a 2002 national survey, only 27% of hospitals had
implemented nursing information systems,9% were developing them, and 24% were NURSING INFORMATICS IN THE PACIFIC RIM: NEW ZEALAND
making plans to develop them, whereas 40% were not planning to make any investment • The evolution of NI has varied in each of the Pacific Rim countries.
in nursing information systems in the near future. The pattern for long-term-care • The adoption of informatics usually began as a vision by one or more
information systems was similar, in that almost 50% of long-term-care institutes were individual. Such people used any number of opportunities plus their leadership
not planning any investment in information systems and only 19% had installed skills to promote and disseminate the use of information technology to support
information systems. nurses in all areas of nursing practice .This occurred in healthcare ,education, and
government organizations, as well as within the IT industry and via any number
Nursing Informatics Practice of new and existing professional organization.
• Events external to the nursing profession frequently became the catalyst
Computerized care plans are now common in clinical use. Moreover, decision support
stimulating some type of activity by nurses towards the adoption of informatics.
systems to test the integration of medical diagnosis and nursing diagnosis, and expert
• International and multidisciplinary links have assisted theses beginning and its
systems implemented on PDAs for the emergency triage system have been reported.
progression. Australia, New Zealand , and Hong Kong have made considerable
Patients Classification systems have also been applied for patient assessment (Hsu et
progress since the early 1980s,South Korea since the 1990s in this regard,
al.,1996). These system designed to be integrated with costings so as to accurately define
although much remains to be done. Nurses in a number of other countries in this
nursing [Link] addition PDAs have been used recently by nurses in their daily practice.
region have only just begun or have yet to learn about NI although introduction
nurses can chart vital signs and input and output other date at the point of care, and also
and use of these technologies in the industry is progressing rapidly especially in
access patient laboratory data, medication, or medical history without having to go back
Malaysia and Japan.
to nursing stations (Li et al.,1998; Lin and Liao,2003).

SUMMARY:
New Zealand
The Healthcare environment in Asian countries is becoming in hospital due to high
healthcare costs, increasing competition among healthcare organizations, decreased
funding from governments, and costumers with more sophisticated demands. The
introduction of information systems and information technology can help healthcare
organizations to survive under this difficult conditions.
healthcare informatics and the use of information technology has proceeded rapidly in
Asian countries, with exciting developments in the areas of clinical practice, informatics
research and informatics education over the past decade. All of these developments have
improved either directly or indirectly the productivity of healthcare professionals, the
efficiency of the healthcare professionals.
It is clear that professional organizations play a major role in raising awareness, • Has a total population is just over 4 million. These people are predominantly
education, and dissemination off knowledge in health informatics. This is becoming found in Auckland (urban) area.
increasingly complex with the proliferation government initiatives spanning multiple • In 2003, 32, 678 active registered burses and midwives are working in New
government departments, which is a reflection of the multidisciplinary nature of health Zealand with most of them practicing in Auckland. Because of these, the city by
informatics. Nurses as the largest group of health professional, have a major role to play. default, becomes focus of the driven for greater health informatics awareness.
A sound knowledge of the many stakeholders will ensure that nurses can coordinate their

61 62
 • Has seen more collaborative approach resulting in integrated care being seen as -Undergraduate
a priority. Integrated care is being supported by technology. Education
-postgraduate

Research -Evidence-based practice

-Ministry of health

Government -NZ health information

-Service national health information
Notable changes have occurred within New Zealand nursing legislation that impact the
roles of future nurses: -MoH, DHB, HB
Funding
-Pharmacy, ACC, private
2. Nursing Council of New Zealand established the new role of nurse practitioner.
3. Legislation was passed permitting nurse prescribing. -Political arena
Informatics influences
-Leadership alliance
Health Practitioners Competence Assurance (HPCA) Act (2003)
-Private act health
-requires each health practitioner group to describe its profession in terms of scopes of -Information privacy code
Legislation
practice. The purpose of scopes of practice is to ensure the safety of the public by
defining the health services that health practitioners can perform. -Heath and disability act
Healthcare Funding Framework:

•The government, through the Ministry of Health chiefly funds healthcare in New
Zealand.
•Healthcare is available for all resident New Zealanders.

-Hardware •The cost of every consultation with the general practitioner is subsidized by the
government.
-infrastructure
Technology trends Information Governance
-internet software
•New Zealand Health Information Service (NZHIS) controls the national database,
-portability
which holds registration for 95% of New Zealanders.
-Groups HINZ
•The NZHIS database uses unique identifier, which is assigned at birth, and is designed
-HIANZ to follow the individual through each healthcare event in his or her life.
-Health IT cluster •The unique identifier is called national health index number (NHI)- it allows easier
Health informatics tracking of information through healthcare episodes.
-HISO
•All information collection, storage, access and retrieval in New Zealand is governed by
-Checkmate
the Privacy Act (1993) and the Health Information Code (1994) and subsequent
-HL7 amendments. This act is one of the most comprehensive pieces of privacy legislation
anywhere in the world.

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 • The health environment is changing at an ever-increasing pace due to the
New Zealand Health Informatics Groups proliferation of new and emerging technologies. Embracing the advances in technology
enable them to deliver healthcare in new and innovative ways.
Ministry of Health (MoH)
• New Zealand has been embracing these changes in technology and has particularly
• -plays an important role for the formal intra- and inter- government liaison work benefited from the development of infrastructure.
it undertakes, it’s influence on sector policy and strategy, and it’s funding
• Higher speed networks including wireless and broadband are enabling information in a
capability.
variety of formats to be shared. Digital images are becoming the norm as
Health Informatics New Zealand (HINZ) well. Exploration into telehealth has occurred in a number of fields including
teledermatology, teleradiology, telepsychiatry and telepediatrics.
• a national, non-profit organization whose focus is to facilitate improvements in
• Improvements in portability are now allowing the use of technology in greater range
business processes and patient care in the health sector through the application
of settings. Examples are the personal digital assistants (PDA) and tablets are being
of appropriate information technologies.
used or trialed in the clinical settings both students and healthcare professionals.

District health Boards New Zealand (DHBNZ) • New Zealand Ministry of Health prepared a 5-year broad strategic directive for
information and technology developments, referred to as “The WAVE Report.”
• is a national organization that has been set up by the 21DHBs to assist with This identified New Zealand’s most pressing health IT needs and significant
representation, help coordinate joint DHB processes and activities, and issues that will continue to form barriers to improved health outcomes and
undertake work that can be done more effectively and efficiently on a notional reducing delivery costs over the next 5 years.
basis. • Following the WAVE Report, the ministry of health directed that a WAVE working
group, the Ministerial Committee on a Health Information Standards Organization
(HISO), be established to investigate the implications of establishing a non-
Independence Practitioners Association Council (IPAC) statutory organization to manage health information standard.

• a group of key technical people “GEEK” who work within the IPAC structure and Scope of development activities under HISO includes the following categorization
who have established a regular forum to discuss issues and share scheme:
information. This group includes some vendor representatives.
•Records structure and contents – data formats.
•Vocabulary – codes for medical and other healthcare terms.
Accident Compensation Corporation (ACC)
•Messaging – standards used for the interchange of data.
• administers New Zealand’s accident compensation scheme, which provides
accident insurance for all New Zealand citizens, preventing injury, buying health •Security and privacy – how access to information is managed.
and disability support services to treat, care for and rehabilitate injured people. In New Zealand, NI has been recognized as significant by the Ministries of Health and
Education since the early 1990s. A national “Guidelines for Teaching Nursing
Health Information Association of New Zealand (HIANZ) Informatics” curriculum was introduced into the undergraduate preparation of nurses
programs.
• is involved with medical records and medical libraries.

Changes have taken place in undergraduate nursing education, including the computer
Technological Trends literacy of entering students and the credentials with which hew nurses qualify.

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NURSING INFORMATICS IN THE PACIFIC RIM: AUSTRALIA
Australia is a federation of eight states. It has population of just fewer than 20
million. Around 225,000 registered and enrolled nurses are employed in acute hospital,
aged and community care in Australia. Of these 89% are employed as a clinical nurse.

NOTE: Nurses were the second group of health professional to organize themselves to
promote health informatics in Australia.

YEAR By Whom Purpose

• As a consequences of the globalization of the profession , Australia changes in
Royal Australian Nurses Adoption of computerized in health
the healthcare industry resulting from technology and informatics advances, 1984
Federation (RANF) service.
changes are being witnessed in the nursing workface.
7th National Conference, “INFORMATION
Royal College of Nursing
1985 PROCESSING CHALLENGES AND
• Australia has more than 50 national nursing organization (NNOs), which include Australia (RCNA)
CHOICES FOR NURSES.”
the Health Informatics Society Australia’s nursing informatics special interest
Royal Adelaide Hospital Nurses Sponsored the national nursing
group (HISA NI Sig). 1986
Education Fund conference “FROM LAMP TO LIGHT PEN.”
• HISA NI Sig has been funded to develop a strategic plan for NI capacity building Royal Australian College of Standards for computerized medical
1988
,and a plan for the nursing profession’s engagement with the Australian General Practitioners (RACGP) records system released.
government and its informatics agenda. YEAR By Whom Purpose
Secured an affiliation with Australian
• Nov.2003 - Australian Health Minister’s Conference has announced that Australian Medical Informatics
1989 Computer Soc. (ACS) AND became the
a national nursing taskforce would be established to drive major nursing Association (AMIA)
ACS medical Informatics Sig.
education. Australia Medical Informatics 16 health informatics enthusiasts met in
1990
Association in South A SA and established AHIA SA
Organized a 1 day health track in
1991 ACS medical [Link]
Adelaide
Health Informatics Standards Comitee-
1992 Standard Australia (SA)
IT-14 established

NIA was reconstituted AS THE HISA

1993 HISA Victoria
Victoria branch.

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 NIA secretariat became HISA’s
1994 HISA constituted
secretariat.

HISA became the official group to

1995 HISA
represent Australia at IMIA.
HISA Nursing Informatics special interest
1996 HISA NI Sig group established. Now known as
Nursing Informatics Australia (NIA)
YEAR By Whom Purpose
Established by GPs, funded by Australian
General Practice
1997 Government Department of Health and
Computing Group (GPCG)
Aging
A new constitution was adopted making
2000 HISA
HISA a company of its members.
Australian College of Health
2001 Meeting of 7 health informaticians.
Informatics (ACHI)

A health Level Seven (HL7) user group

2002 HL7 Australia
established

Hosted an international ISO TC215

2002 HISA
meeting in Melboure.

2003 HISA A pathology SIG established.

2004 HISA An Aged care SIG established

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