Developments in Nursing Practice
Introduction to Health Informatics
Informatics
 Informatics includes the science of information,
the practice of information processing, and the
engineering of information systems.
 Informatics studies the structure, behavior, and
interactions of natural and artificial systems that
store, process and communicate information.
 It also develops its own conceptual and theoretical
foundations. Since computers, individuals and
organizations all process information, informatics
has computational, cognitive and social aspects,
including study of the social impact of information
technologies.
1. What is health informatics?
 From the French ‘informatique’
 Medical informatics, medical computing,
computers in medicine,….
 Interdisciplinary field combining health
sciences, computer science, statistics,
engineering, management sciences,…
 Many definitions….
Some definitions of health informatics
‘an umbrella term referring to the application of the
methodologies and techniques of information science,
computing, networking and communications to support
health and health related disciplines such as medicine,
nursing, pharmacy, dentistry etc……’ WHO
‘ the field that concerns itself with the cognitive, information
processing, and communication tools of medical practice,
education, and research including the information science
and the technology to support these tasks’ (Shortliffe)
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Nursing informatics
 Nursing informatics is the integration of nursing, its
information, and information management with
information processing and communication
technology, to support the health of people world
wide .
 Nursing Informatics is a specialty that integrates
nursing science, computer science, and information
science to manage and communicate data,
information, and knowledge in nursing practice.
Who does health informatics
serve?
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Patient
Medical Profession
Government Bodies
Primary Care/GP’s
National Agencies
Finance/Admin. Management in Hospitals
Tax Payers
General Population
The public
Policy makers (strategic management)
Regional managers/tactical management
Facility management/operational management
Health care providers
Healthcare researchers
Healthcare educators and their students
Will one solution suit all?
What services does Health
Informatics involve?
 Data processing – (health is a data intense industry)
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Includes collection, processing, transformation, presentation &
use
 Communication – main emphasis should be on
supporting communication between people
 Knowledge based services
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Includes computerised bibliographic services, on-line
collections on non-numerical information such as
practice guidelines, pharmacopoeias, essential drug lists,
telephone directories, expert, decision-support and
reminder systems
What technologies does it
employ?
 Computers and networks……
But don’t forget paper-based information systems, including
input to and output from the computer
Applications of Health
Informatics
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For recording accurate data
To have data available in a timely manner
Support and inform managers to make better decisions
Resource allocation and planning
Email therapy
Risk management
Training
Support for shared care
Patient Assessment
Evaluation of patient care
Monitoring patients
Staff coordination
Tracking patients in hospital
Stock management
Tracking sterile supplies
Integration engines
Mobile computing
Applications of Health
Informatics contd.
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Drug control – medication dispensing/ordering
Purchasing equipment
Payroll
Clinical Pathways
Labour management
Patient scheduling
Budget analysis
Research
Word processing
National database
Quality Assurance
Donor databases
Devices
Monitors
Analysers
Imaging equipment
Imaging systems in Health
 Impossible without the use of computers
 Computers are used to:
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Construct an image from measurements
Obtain an image reconstructed for optimal extraction of a
particular feature from an image
Present images
Improve image quality by image processing
Store and retrieve images
 Ulstrasound, x-rays, computed tomography, MRI,
nuclear imaging etc. ….
Telehealth
 Telehealth is the delivery of health-related services
and information via telecommunications
technologies.
 Telehealth delivery could be as simple as two health
professionals discussing a case over the telephone,
or as sophisticated as using videoconferencing to
between providers at facilities in two countries, or
even as complex as robotic technology.
 Telehealth is an expansion of telemedicine, and
unlike telemedicine (which more narrowly focuses
on the curative aspect) it encompasses preventive,
promotive and curative aspects. Originally used to
describe administrative or educational functions
related to telemedicine, today telehealth stresses a
myriad of technology solutions. For example,
physicians use email to communicate with patients,
order drug prescriptions and provide other health
services.
Clinical uses of telehealth
technologies
Transmission of medical images for diagnosis
(often referred to as store and forward telehealth)
Groups or individuals exchanging health services or
education live via videoconference (real-time
telehealth)
Transmission of medical data for diagnosis or
disease management (sometimes referred to as
remote monitoring)
Advice on prevention of diseases and promotion of
good health by patient monitoring and followup.
Nonclinical uses of telehealth
technologies
Distance education including continuing medical
education, grand rounds, and patient education
Administrative uses including meetings among
telehealth networks, supervision, and presentations
Research
Online information and health data management
heathcare system integration
patient movement and remote admission
Telehealth modes
Telenursing
 Telenursing refers to the use of
telecommunications and information technology for
providing nursing services in health care whenever
a large physical distance exists between patient and
nurse, or between any number of nurses.
 As a field it is part of telehealth, and has many
points of contacts with other medical and nonmedical applications, such as telediagnosis,
teleconsultation, telemonitoring, etc.
eHealth
 eHealth (also written e-health) is a relatively
recent term for healthcare practice which is
supported by electronic processes and
communication. The term is inconsistently used:
some would argue it is interchangeable with health
care informatics and a sub set of Health informatics,
while others use it in the narrower sense of
healthcare practice using the Internet. The term can
encompass a range of services that are at the edge
of medicine/healthcare and information technology
 Electronic Medical Records: enable easy communication
of patient data between different healthcare professionals
(GPs, specialists, care team, pharmacy)
 Telemedicine: includes all types of physical and
psychological measurements that do not require a patient to
travel to a specialist. When this service works patients need
to travel less to a specialist or conversely the specialist has a
larger catchment area.
 Evidence Based Medicine: entails a system that provides
information on appropriate treatment under certain patient
conditions. A healthcare professional can look up whether
his/her diagnosis is in line with scientific research. The
advantage is that the data can be kept up-to-date.
 Consumer Health Informatics (or citizen-oriented
information provision): both healthy individuals and patients
want to be informed on medical topics.
 Health knowledge management (or specialist-oriented
information provision): e.g. in an overview of latest medical
journals, best practice guidelines or epidemiological
tracking.
 Virtual healthcare teams: consist of healthcare
professionals who collaborate and share information on
patients through digital equipment .
3. Why bother?
 Information Technology is now an integral and
essential part of health delivery
 IT systems are prevalent in society
 Training and education in the appropriate
application of IT in healthcare essential - Council
of Europe
4. Health sector today
(citizen-centred care)
 Health and education are two major consumers of the public purse
 Situation in the sector
 Cost containment
 Information overload (data doubles every five years)
 Shared care (team based care)
 Technological push vs. demand pull (users driving it)
Clinical focus - Should be driven by supporting clinical
needs and not financial management (otherwise solutions in
search of problems)
 Cost containment is major driving force – planning resources (eg. cost of
care for diabetes)
 Improving quality of care equally important
Health sector today contd.
 Distributed organisational structures (independent
clinics/labs) – strong local autonomy
 Accountability
 Increased dependence on automation
 Emphasis is moving from administrative to clinical
information systems
 Public has more knowledge about healthcare (NLM,
Medline, Web)
 Tension between demand for increased quality of care vs.
reduction in costs
 Efficiency vs. cost-effectiveness
Health sector today contd.
 Information overload – nos., text, x-rays,
ultrasounds
 Complex (narrative)
 Distributed
 Multi-vendor (heterogeneous) – no one vendor can
support all the processing needs of all systems, GP,
A&E
 Strong autonomy (need to relinguish a certain
amount of automony to share data)
 Data intensive
Implications for healthcare
organisations
 Unnecessary duplication of tests and investigatons
 Valuable time wasted trying to track down relevant
information
Studies have shown that at least 20% of healthcare
professionals time is spent reading, writing, sorting and
searching through notes (up to 70% has been claimed by
some)
=>Appropriate healthcare not provided as efficiently and
cost effectively as possible
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The strategy to improve the situation should
include the following ideas..
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Patient care requirements prime
Secure, reliable, on-line clinical information systems
Facilitate cost-effective use of IT
Establish stewardship for implementation of enterprisewide solutions and standards
 Connect and manage distributed information systems
 Delivering healthcare today is no longer the sole
responsibility of a single professional
 Movement away from hospital (tertiary) to community
(primary) – based shared care (Access to records by GPs)
This implies….
 Ability to share information between care providers
is key
 The right information in the right place, in the right
format and at the right time
 IT is key-enabling technology for shared care
 Tension between demand for increased quality of
care vs. reduction in costs
 Efficiency vs. cost-effectiveness
The key issue is……
 Efficient and cost-effective application of
ICT in the health sector
6. Challenges….
 Legacy information systems (older systems)
 Problems –
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Maintenance 80% of IT costs (eg Y2K problems)
Inflexible and brittle (cannot interface with newer
systems – can crash/old code not properly documented
(cannot interface with new systesm)
 Fear
 Challenge
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Migrate/evolve
 IT gets in the way sometimes
Technical Challenges contd.
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Complex nature of medical data
Alphnumberic (lab results)
Text (discharge summary)
Signals (monitors)
Images (x-rays)
Video (endoscopy, ultrasound)
User interfaces – data entry
Highly reliable, efficient and secure information management
Integration of IT into routine clinical practice – paperless hospital
Co-operative hospital computing
Multi-vendor
What are the Organisational
Challenges
 Integrating IT into the business process
 Understanding the domain to which the
application is being applied
 Training Staff on the new systems
 Introducing the new systems to patients
 Maintenance of the systems
 Resources – location, staff, money