nursing informatics: Internet tools for advance nursing practice

1. NURSING INFORMATICS
(NI) IS THE SPECIALTY THAT INTEGRATESNURSING SCIENCE WITH MULTIPLE
INFORMATION MANAGEMENT AND ANALYTICAL SCIENCES TO IDENTIFY,
DEFINE, MANAGE, AND COMMUNICATE DATA, INFORMATION,
KNOWLEDGE, AND WISDOM INNURSING PRACTICE.

2. Internet Tools for Advanced Nursing Practice
Objectives:
1. Employ basic and advanced internet search skills in retrieving information pertinent to
advance practice nursing.
2. Access a variety of clinical practice internet-available tools, including bioterrorism
information, organized within nursing process categories.
3. Integrate eClinicaLog and its informatics skills-building components into the
educational development of advanced practice nurse.

3. This topic presents a variety of Web-base applications that help form and knowledge base
of advanced nursing practice.
Information relevant to clinical decision-making continues to expand, and its relevance
will only increase as the electronic health record becomes a standard part of practice.
Basic and advanced internet search skills are needed to adapt to a frequently changing
internet environment and to retrieve the wealth of internet information applicable to
clinical practice in an efficient manner.

4. To facilitate adaptation, this chapter
1. Describes basic and advanced internet search methods
2. Structures the presentations of internet-available clinical practice tools
3. Discusses the eClinicaLog and its applicability

5. Basic and Advance Internet Search Methods
Regardless of the search engine used, certain search methodologies, if applied correctly,
increase the efficiency of retrieval if needed information. The three strategies are:
· 1. Name precisely the information being sought. If the search terms used precisely chosen,
the searcher goes directly to the desired information.
· 2. Use a search string (one or more search terms) rather than a single word to increase
the preciseness of a search. Enter the precise terms in a string, rather than a single term.
· 3. Enhances search strings by Boolean or natural language methods. Use Boolean terms:
AND, or, not. The term “AND” is used when search terms or strings need to be added together.
The term “OR” is used when equivalent terms or synonyms are used to capture the
information.

6. Internet-Available Clinical Practice Tools
This section is divided into the most basic components of nursing process: assessment,
diagnosis, treatment, and outcome evaluation. These component provide the outward
structure for development of a clinical information database for advanced practice
nursing.

7. 1. Assessment
Assessment refers to the systemic collection of data needed to arrive at one or more
diagnoses. The tools included in this section include forms, miscellaneous screening
tools, risk assessment instrument, and information, and information of the manifestation
of signs and symptoms. These tools represent a sampling of assessment content
available on the internet.
Nursing assessment is the first step in nursing process. The following site provides an example of a comprehensive
nursing assessment form:
· http://www.hospitalsoup.com/public/nursinggassess2001.pdf
· http://www.niaaa.nih.gov
· http://www.state.vt.us/health/abuse.htm
· http://www.ctclearinghouse.org/

8. The assessment of symptoms of illness and the education of patients regarding symptoms
are major responsibilities of the advance practice nurse. And outstanding resource for
consumers and health professionals in the information available through the following
NLM MEDLINE plus Health information
hyperlink: http://search.nlm.nih.gov/homepage/query?FUNCTION=seach&PARAMETE=M
EDLINE+Plus+ANS+symptoms+AND+manifestation&DISAMBUGUATION=true&START=0&S
TART=0&END=25&MAX=250&ASPECT=1

9. 2. Diagnosis
Treatment is diagnostic specific. Hence, diagnosis and treatment information categories
are frequently not discreet.
The section diagnosis is divided into following sections:
1. new threats to health, disease/ condition directories,
2. examples of specific disease information,
3. easy diagnosis tools, standardized diagnosis terminologies,
4. and the unified medical language system (UMLS)

10. New Threats to health. New threats to health include mass trauma, biological and
biochemical warfare agents, and emerging infectious disease. Primary care and
emergency department practitioners need readily accessible information to
facilitate diagnosis. The CDC’s emergency Preparedness and Response web page is
excellent source: http://www.bt.cdc.gov/
Mass Trauma Preparedness Response. Mass trauma hyperlinks, featured on CDC
Emergency Preparedness and Response webpages include coping with a traumatic
event, a primer for clinicians on dealing with explosions and blast injuries, fact
sheets for injuries and mass trauma; possible research studies; and rapid
assessment of injuries.

11. Bioterrorism Agents/ Diseases.
The CDC emergency preparedness and response
webpages present information on approximately
30 diseases.
When a particular hyperlink, is activated, the
information is available for everyone, specific
groups, and diagnostic testing, infection control,
and other s specialized information for health
professionals.
Photographic images and/ or video presentations
facilitate clinical decision-making related to
infectious agents that may be used for
bioterrorism purposes.

12. Clinical Agents.
The CDC Emergency Preparedness and
Responsiveness webpages hyperlink information
to more than 70 chemical agents. Some of the
hyperlinks represent categories of agents.
Recent Outbreaks and Incidents.
The Emergency preparedness and response page
also includes information on outbreaks. Detailed
information is provided on each.

13. Bioterrorism Information Available through
Academic Health Science Center.
Several academic health science centers have
received federal funding to move biodefense
research and education forward. These sites
include the following.
a. Agency of Healthcare Research and
Quality in collaboration with the University of
Alabama has a web site devoted to
bioterrorism education.
http://www.bioterrrorism.uab,edu/

14. b. George Manson University Center for
Biodefense
- http://www.gmu.edu/centers/biodefense/
c. Saint Louis University Center for study of
Bioterrorism and Emerging Infections
- http://www.bioterrorism.slu.edu/
d. University of Pittsburgh Center for Biosecurity
- http://www.upmc-biosecurity.org/

15. Disease diagnoses – the most familiar disease
terminology is the ICD (World Health Organization,
1992).
For use in united states, Who has authorized the
Department of health and Human Services National
Center for Health Statistics to develop, in keeping
with WHO ICD conventions, ICD-10-CM, where CM
refers to clinical modification. A prerelease version is
available for review at the national center for health
Statistics
(http://www.cdc.gov/nchs/about/otheract/icd9/abtic
d10.html )

16. There are several disease directories with A-Z lists,that are Internet available. Example
include:
a. Centers for Disease Control and Prevention (CDC), disease and conditions. The
hyperlink is available in the left hand margin of the CDC homepage ( www.cdc.gov )or may be
accessed directly at http://www.cdc.gov/node.do/id/0900f3ec8000e035 .
b. A-Z list of cancers from the National Cancer Institute ( www.nci.nih.gov )
c. The Karolinska Institute University Library in Sweden (http://www.mic.ki.se/Disease/ )

17. For disease definitions, online medical dictionaries are useful. One
example is the on-line Medical Dictionary published by the University of
Newcastle upon Tyne Department of Oncology
( http://cancer-web.ncl.ac.uk/omd ).
Its listing, which is not limited to oncology-related diseases,
It is a readily accessible, comprehensive dictionary.

18. New York online Access to health
( www.noah-health.org ).
The latter site has an A-Z Index, which is
especially useful for providing laypersons with
information on uncommon illness, for example:
lupus erythematosus, Marfan’s syndrome.

19. Many internet sites provide clinical information on tools useful in the diagnosis of specific
diseases.
Human Response to Illness/ Health Diagnoses- the internet tools presented in this section
are infrastructure tools, because much of work that need s to be accomplished in the field
in nursing diagnosis is at the infrastructure level
Terminologies designed for or listing nursing diagnoses include NANDA Diagnoses and
classification, Home Health Care Classifications, The Omaha System and the
perioperative nursing data set
( http://www.aorn.org/research/pnds.htm )

20. Methods of Contributing to Terminology
Revision and Development- like the ICD,
standardized nursing terminology is in continual
need of revision and development. Clinician,
informaticists, researchers, educators, and
students may contribute to this process.
Revision and new diagnosis submission forms and
instructions are available at NANDA Web site
( www.nanda.org ) and the network for language
in Nursing Knowledge Systems Concept Analysis
Center
( http://nlinks.org/cac_introduction.phtml ).

21. 3. Treatment
The term “treatment” is used in lieu of interventions and nursing actions, because
it expresses more precisely the broad clinical management focus of this section.
Nursing treatment
Several Internet sites are available for those who desire more information on
Saba’s framework/structure examples, a NIC intervention example, Omaha System
case studies, and PNS examples and outcomes.

22. These are:
· Home Health Care Classification ( Saba,2003,
www.sabacare.com )
· Nursing Intervention Classifications (NIC)
http://www.nursing.uiowa.edu/centers/cncce/nic/index.htm
· Omaha System(Martin, Elfrink, and Monson, 001,
http://www.omahasystem.org/ )
· Perioperative nursing data set
( http://www.aorn.org/research/pnds.htm )

23. Calculators- internet tools are available to facilitate calculations used
in planning treatment. Examples include:
· Martindale’s Calculators Online Part I: Nutrition -
(http://www/martindalecenter.com/Calculators1B_4Nut.html )
· Nursing calculators for drug administration purposes
(Villanueva,
http://www.manuelsweb.com/nrs_calculators.htm )
· Medical calculators developed by Cornell University Medical
College, Pediatric Critical Care Medicine.
( http://www-users.med.cornell.edul/~spon/picul/calc/medcalc.htm )

24. Drug Management- there is no shortage of
information available on pharmacotherapeutics
and pharmacologic management of patients. The
federal government provides wealth of
information.
1. Drug Enforcement Agency (www.dea.gov ),
excellent information on drugs and chemicals of
concern
http://www.deadiversion.usdoj.gov/drugs_conce
rn/index.html ).

25. 2. Food and Drug Administration (www.fda.gov ), with
outstanding search capability Clinicians need to
remember that herbal products, even thought
pharmacologically active, are listed under “FOODS” and
not under “DRUGS.” Within the FDA Web site, the
following are especially useful pages.
a. Center for Drug research and evaluation
(http://www/fda.gov/cder/index.html )

26. b. Medwatch: the FDA Safety Information and Adverse
Event Reporting Program
( http://www.fda.gov/medwatch/index.htm )
c. Medwatch Adverse Event and Product Problem Forms
(http://www.fda.gov/medwatch/get-forms.htm )
d. Vaccine Adverse Event Reporting System
(http://www.fda.gov.medwatch/safetly/vaers1.pdf )

27. 3. NLM Clinical Alerts Database, may accessed in the left
hand margin of the www.pubmed.gov web page directly
at http://www.nl.nih.gov/data-bases/alerts/clinical_alerts.html .
4. The National Institutes of Health ( www.nih.gov ) provide
outstanding drug information. See especially the following.
a. National Institutes on Alcohol Abuse and Alcoholism
( www.niaaa.nih.gov )
b. National Institutes on Drug Abuse ( www.nida.nih.gov )
c. National Center for Complementary and Alternative
Medicine ( www.nccam.nih.gov )

28. 5. The CDC ( www.cdc.gov ) provide a wealth of information
of vaccines as well as annually updated vaccine schedules for all
age groups.
a. CDC Vaccines and Immunization Program
( http://www/cdc.gov/node/.do/id/0900f3e8000e2f3 )
b. CDC National Immunization Program
( http://www.cdc.gov/nip/ )
c. More information on vaccines
( http://www.cdc.gov.nip/menus/vaccines.html )

29. 6. University sites are excellent sources of information as well
examples include:
a. indiana university- purdue university Indianapolis for its P450
drug interactions table-
( http://www.medecine.iupui.edu/flockhart/table.htm )
7. There are also commercial sites that provide readily accessible
manufacturer’s information on drugs. These includes:
a. medscape ( www.medscape.com ).
b. Rxlist ( www.rxlist.com )

30. Outcomes
Outcomes measurement is a tradition within
nursing practice. Many categories of patient
outcomes are measured today.
This section provides examples of outcome
measures within several categories. The
categories are patient safety, nursing outcomes,
nursing home and home healthcare setting
outcomes, health plan outcomes, and the short
form health survey.

31. 1. Patient safety- is an outcomes issue. There are several patient safety sites, which are
prime importance to advanced practice nurses.
They include the following:
a. Agency for Healthcare and Research and Quality web Morbidity and Mortality
Rounds, an online forum for presentation and discussion of medical errors
( www.webmm.ahrq.gov/ )
b. The patient safety page of www.Medscape.com
c. Institute for Healthcare Improvement ( http://www.ihi.org/ihi )

32. 2. Nursing outcomes-
the internet sites presented within this section refer to
standardized nursing-terminologies that either present
outcomes in a structured format or data set that may be
used evaluative purposes.
a. Information of Nursing Outcomes Classification
may be obtained from the University of Iowa Center of
Classification and Clinical Effectiveness
( http://www.nursing.uiowa.edu/centers/cncce ).

33. 3. Nursing Home and Home Healthcare Setting
Outcomes – related nursing outcomes are those
measures that evaluate the quality of care within
nursing homes and healthcare settings.
a. Oasis (outcomes assessment information set )
measures are used to evaluate quality within home,
healthcare settings
(http://www.cms.hhs.gov/quality/hhqil/HandOut1.
pdf ).

34. 4. Office Tools: Online Health Record Audit and Patient Satisfaction Forms- until the
electronic health record is universal, the completeness of the health record or specific
aspects of care need to be evaluated manually. The following links provide resources on
auditing the health record and patient satisfaction.
a. Health Care Record Audit Criteria, adapted from the Santa Barbara Regional Health
Authority
(http://www.sbrba.org/section/ensuring_quality/provider_audit/pdfMedical_Record_revi
ew_Criteria.pdf )
b. Patients Satisfaction Form (four-point scale)-
http://www.geomedics.com/downloads/pss4.rtf
c. Patients Satisfaction Form (five-point scale)-
http://www.geomedics.com/downloads/pss5.rtf

35. 5. Outcomes Measurement: Internet-Available
Biostatistical and Analytical Tools- although the
biostatical measurement of outcome variables is
not a routine part of clinical practice, it is likely to
assume an important role when new programs or
initiatives are begun.
following sites provide basic biostatistical tool
available online including an AOL listing that
includes free software and software packages
available through CDC.

36. a. Qualitative data creation, management, and analysis software
(CDC, http://www.cdc.gov/hiv/software/ez-text.htm )
b. Qualitative Database Software
(CDC, http://www.cdc.gov/hiv/software/answer/howto.htm )
c. Epidemiologic analysis software (CDC, http://www.cdc.gov/epiimfo/ )
d. Chi-square calculator (Georgetown
University, http://www.georgetown.edu/faculty/ballc/webtools/web_chi.html )
e. Student’s t-test calculator (http://www.physics.cbsju.edu/stats/t-test.html )

37. eCLINICALOG (http://www.eclinicalog.org ), A Web-
Based Clinical Encounter Database
Healthcare settings are integrating clinical information
systems into all aspects of care planning, delivery, and
evaluation.
To prepare clinicians to recognize and capitalize on the
potential of this information to affect health
outcomes, informatics needs to be integrated into the
clinical course work.

38. The eClinicaLog is part of an educational strategy,
initially designed to build data entry, analysis, and
synthesis skills in nurse practitioner students. As
its version have evolved, eClinicaLog has become
relevant to undergraduate education as well.
Like other Logs, eClinicaLog started out as paper
and pencil format. Nurse practitioner students
used logs to track the number of patients seen in
clinical practical and record basic demographic
data, medical diagnoses, and medication
prescribed.

39. The first version of what became the eClinicaLog
was spiral-bound, legal-sized, two-page grid of
boxes the student filled in. This version lasted 1
year. Analysis of the paper version was time-
consuming and frustrating.

40. The next version addressed issues of
irretrievability, familiarity , availability; student
acceptance, curricular congruence, and
contribution to discipline.
The eClinicaLog consisted of three categories of
variable: patient, program, and demographic.
Since inter-professional collaboration is an
important aspect of care delivery, it was
important for nurse practitioner students to
understand and use standardized terminologies
from several disciplines.

41. The learning process has been accelerated not
only by having the clinical log available on the
Web, but to have supportive information
available on the internet also.

42. Nursing Informatics and its International Perspective
• Nursing Informatics in Canada
• Nursing Informatics in Europe
• Nursing Informatics Asia
• Nursing Informatics in South America
• Pacific Rim

44. The Canadian Nursing Informatics
Association (CNIA) exists to help nurses
across Canada to learn, share, research, and
create informatics-related projects and
experiences that can help to boost the
competencies, theory, and practice of
informatics on a national level.

45. About the Canadian Nursing Informatics Association Mission
To be the voice for Nursing Informatics in Canada. The CNIA is the culmination of
efforts to catalyze the emergence of a new national association of nurse
informaticians.

46. Goals
 To provide nursing leadership for the development of Nursing/Health informatics
in Canada.
 To establish national networking opportunities for nurse informaticians.
 To facilitate informatics educational opportunities for all nurses in Canada.
 To engage in international nursing informatics initiatives.
 To act as a nursing advisory group in matters of nursing and health informatics.
• To expand awareness of Nursing Informatics to all nurses and the healthcare
community.

47. Who Joins?
The CNIA is for any one interested in nursing informatics!
This may include individuals:
 Interested or working in nursing informatics
 Working with clinical information systems, nursing workload systems, etc
 Responsible for managing or leading projects related to health/nursing
informatics
 Interested in networking with other individuals in nursing informatics
 Teaching nursing informatics
 Interested in developing standards for nursing informatics
• Interested in better understanding nursing informatics

48. The use of technology in nursing is not new,
in fact nurses have become proficient in
utilizing and adapting complex technology
into caring nursing practice for decades, at
least since the time of Florence Nightingale in
the United Kingdom and even earlier.
Various forms of machinery such as
ventilators and physiological monitors were
first used in intensive and critical care
settings, and are now currently used in
adapted form in less acute areas, even in
home care.

49. Nursing has evolved significantly over the
past few decades, with many of the changes
being driven by advances in information and
communication technology (ICT)
Since nurses are the largest group of health
care providers, discipline-specific
competencies in the use of ICT and other
technologies are imperative. This realization
has catalyzed the steady development of
nursing informatics. “Nurses in Canada have
made an enormous contribution to all aspects
of Canadian society.

50. The National Nursing Informatics Project
In 1998, the Canadian Nurses Association
spearheaded another initiative, the National
Nursing Informatics Project, to begin to
develop a national consensus on definition,
competencies, and educational strategies and
priorities in nursing informatics
development.

51. In 1998 a national steering committee was
formed to address Nursing Informatics issues
and develop strategies to ensure that
Registered Nurses have the competencies
required to successfully carry out the
responsibilities of their practice - whether
that be clinical, administrative, educational
or research.

52. Different participating organization in
Canada appointed a nurse expert in Nursing
Informatics to a five-member working group
to develop and initiate a plan to:
 develop consensus on a definition of Nursing Informatics for Canada;
 recommend Nursing Informatics competencies for entry level nurses and
specialists, managers, educators, and researchers;
 identify curriculum implications and strategies for both basic and
continuing nursing education; and
 determine priorities for implementing national nursing informatics
education strategies.

53. Another influential group, the Canadian
Institute for Health Information
(CIHI) also plays a unique and crucial role in
the development of this new Canadian health
information system.
CIHI has described its' role as:
1. Setting National standards for financial, statistical, and clinical data
2. Setting National standards for health information technology,
3. Collecting, processing, and maintaining health related databases and registries

54. Over the last two decades Canadian leaders in
nursing informatics have discussed and
conceptualized a nation wide nursing
informatics strategy that would benefit all
nurses and nursing students.
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
strategy.

55. “The purpose of the e-nursing strategy is to guide the
development of ICT initiatives in nursing to improve nursing
practice and client outcomes”

56. Nursing Informatics in Europe
In Europe, as in many countries worldwide, the main rational for implementing a
greater use of information technology (IT) in the healthcare sector is to improve
safety and quality, improve patient outcomes, and at the same time try
to reduce costs of healthcare.

57. The main mission, in Europe, is to
established a stable infrastructure quality,
facilitates the reduction of errors, and the
delivery of evidence-based and cost-
effective care.
Some core building blocks of this are
electronic health record (EHRs), nursing
informatics education at all level,
communication and terminologies, and
standards for technology, communication,
and patient care .

59. National IT Strategy
There are many European countries that have
developed national policies and strategies.
The government’s IT policy in Sweden has
three objectives:
• confidence in IT,
• competence to use IT, and
• information about society services
available to all citizen.
One goal is that all households and
companies in all parts of Sweden within a few
years should have access to an IT
infrastructure with high-speed connections.
•Another goal is the ability to communicate
between systems.

60. The directors of all regional healthcare
services in Sweden have agreed to develop
their hospital systems so that they can
communicate with each other nationwide and
still keeping confidential rules.
Patient Participation
Studies have found that improved patient
participation and the consideration of patient
preferences have improved outcomes and
treatment adherence, as well as increased
patient satisfaction with their care.

61. Continuity of Care and Availability of Information
Telemedicine or telehealth, which is the practice of
medicine and nursing over a distance where data and
documents are transmitted through
telecommunication systems, is widely disseminated in
parts over Europe.
According to their own reporting, many countries,
such as Austria, Germany, Greece, Slovenia, France,
United Kingdom, Ireland, Belgium, Denmark,
Norway, Finland, Sweden, Iceland, Portugal, Spain
and Italy are practicing telemedicine.

62. Electronic Patient Records
All registered nurse (RN) in Sweden are by law, since 1986, obliged to document
nursing care.
•Regulations emphasize the RNs have an autonomous responsibility for planning,
implementing, evaluating nurse care and that nursing diagnoses in the patient
record is a part of that responsibility.
•Nurses gradually have accepted the idea of nursing diagnoses, but there are no
agreed standardized expressions or routinely implemented nursing diagnoses in
practice. Sweden nurses prefer the use of problem statements.

63. A Sweden study by the National Board of Health and
Welfare (2000) can be used to illustrate the increasing
amount of information in healthcare:
In 1971 a 4-week hospital stay generated three sheets of
paper,
in 1984 it generated 18 sheets and
in 1999 a shorter stay of 10 days generated 34 sheets of
record information..

64. Dissemination of Electronic Patient Records
In Norway and Sweden EPRs are quite
common both in primary healthcare and in
hospitals.
In Sweden the estimated occurrence of EPR
in primary healthcare is 85-90% while the
percentage for hospitals is about 40%. In
Norway there are EPRs for 81% of the
hospital beds.

65. Since computers were first introduced into the health
care sectors of Asian countries in he 1970s, there have
been exciting developments in the healthcare
informatics associated with the rapid growth in
information and communication technology.
this topic provides an overview of the current status of
the field of NI in south Korea, Japan, China, Taiwan, and
Thailand. It describes the history of NI , the use of
informatics in clinical practice, informatics education,
informatics education, informatics research, and
government initiatives and professional outreaches.
Nursing Informatics in Asia

66. South korea
comprises 8 provinces with 7 metropolitan cities, and the total population was about 47
million in 2002. The population is predominantly in urban areas, with 21% living with in
the seoul metropolitan area. there are currently 190,720 licensed midwives and nurses, of
whom 81,478 and practicing and 23,331 of these are situated in the seoul metropolitan
area.
The use of computers in south korean healthcare began in the late 1970s in hospital
finance and administration systems to expedite insurance reimburesments. soon
thereafter, the national health insurance system expanded to cover the whole
population, and computers became necessary equipment in healthcare organizations.
The health care informatics and NI were first introduced in 1987.

67. Japan,
there are about 10,000 hospitals, in which 430 of
them have more than 400 beds. Approximately
750,00 nurses work in these hospitals, with about
220,000 nursing aides. Fortunately, easy access
of healthcare in Japan is provided by their
healthcare delivery system.
Japanese citizens can freely choose their medical
institutions and doctors and their financial
contribution is determined by their income, since it
is directly proportional to the income. Also, since
the Japanese have very healthy dietary habits,
their total health expenditure remains lower
compared to that of other advanced nations.

68. In 1980, the Japanese Association of Medical
Informatics was founded. It was in the same
year when Japan hosted the IMIA
conference, MEDINFO80.
This was the third international congress on
medical informatics.
This conference concluded the formation of a
special interest group in Nursing Informatics,
which represented its beginning in Japan. But
unfortunately, it did not result to immediate
progress in Japanese NI education.
Nevertheless, NI was still applied in clinical
practice in the 1990s.

69. CHINA
Majority of the population in China was in the
rural areas. Because of this, the overall
healthcare level was influenced by the
healthcare services in the rural areas.
The SARS epidemic in the country led to
further reconsideration in these rural areas
which led to the Chinese considering that
their healthcare system is not advancing.
The Chinese thought that more effort should
be put in epidemic prevention and that a new
system of medical cooperative care, plus a
new salvation system of the poor should be
up to ensure health in the rural areas.

70. The development of Nursing Informatics
systems in China also began in the late
1970s and was first used in 1987.
In 1981, the China Medical Informatics
Association was founded (CMIS). Meanwhile,
the Chinese Society of Medical Information
(CSMI) was founded in 1993 and its mission
included holding academic conferences and
seminars, continuing education, and training.

71. In 1996, the Hospital Information
Management Association (HIMA) was now
founded and its mission included holding
national and international academic
collaborations and exchanges, establishing
rules and standards of national hospital
management, and training hospital
information management staff.
The term Nursing Informatics was first used
in Chinese literature in 2002.

72. Nursing Informatics in South America
Nursing Informatics in 13 South America countries has been based more on ACTIVITIES of
INDIVIDUALS than on a policy established by governments or national efforts.
Each country has varied levels of development and deployment of technological
resources. Technology is visible tendency in:
1. Health
2. Nursing Education
3. Nursing Practice
4. Nursing research
5. Administration

73. Computers are considered an important tool to help
nurses take care of patients and to organize nursing
service and nursing education.
The growth of information technology in Latin America
and the Caribbean has been consistently the world’s
highest for 20 years.
Health institutes and universities are exploring ways to
introduce news resources on order to facilitate the process
of the patient care and promote quality and safety.
Nursing has been identified around the world as an
emerging profession for over a 100 years.

74. People are able to connect to the internet that is a
telecommunication resource with no parallel to fast
exchange data and information.
In result we can expect to see better-informed
healthcare providers and consumers.
The Pan American Health Organization (PAHO) has
published guidelines and protocols to orient the
development and deployment of information and
communication technology in Latin America and the
Caribbean.

75. A study performed by the PAN America Health
Organization/ World Health Organization
information, computer and social infrastructure is
evolving rapidly.
In South American countries:
The initial motivation to develop computer
systems in the healthcare area was driven by
financial and administrative concerns.

76. In 19th century, Brazil, Mexico, Argentina,
Colombia, Chile, and Paraguay have clinical
information systems in hospitals or health
institutes.
Patient data that are also used for nursing
administration are integrated in the systems or
nurses have to collect and analyze nursing data
separately.

77. Most of the computer systems implemented is
intended to control administration data.
Congresses, conferences, workshops, education,
and training programs are being organized in the
countries to share experiences and information in
nursing informatics searching for solutions that
could enhance the delivery of patient care.

78. Nucleo de Informatica em Enfermagem at the
Universidade Federal De Sao Paulo was the
first center to offer the specialization degree
certificate in South America.
Provides since 1989, the nursing informatics
discipline in its graduate and undergraduate
nursing programs.
The research “line” in nursing informatics is
attended by professionals from different regions
of the country and has been responsible for the
preparation of several master and doctoral
students in nursing informatics.

79. Nursing Informatics at the Pacific Rim
Some of Pacific rim countries includes the ff
New
Zealand
Australia
Hong
Kong
Korea
Malaysia
Japan
Pakistan
Philippines

80. NI technologies in health industry has been
adapted in Australia and New Zealand, Hong
Kong (1980s) and South Korea
(1990s). Progressing rapidly also in Malaysia
and Japan. The rest of the member nations are still
in the learning to gain awareness about the field.

81. Asia Pacific Medical Informatics Association
(APAMI)
Ø was formed in 1993 as a regional group
of the International Medical Informatics
Association (IMIA).
Ø helped launch national healthcare
informatics associations in the Pacific rim.

82. HEALTH AND NURSING INFORMATICS IN NEW ZEALAND
New Zealand’s total population is just over 4 million. These people are
predominantly found in Auckland (urban) area.
In 2003, 32,678 active registered nurses and midwives are working in
New Zealand with most of them practicing in Auckland. Because of
these, the city by default, becomes focus of the drive for greater health
informatics awareness.

83. Health Practitioners Competence Assurance
(HPCA) Act (2003) –
Requires each health practitioner group to
describe its profession in terms of scopes of
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.

84. Information Governance
New Zealand Health Information Service (NZHIS)
controls the national database, which holds
registration for 95% of New Zealanders.
The NZHIS database uses unique identifier, which is
assigned at birth, and is designed to follow the
individual through each healthcare event in his or her
life.
The unique identifier is called national health index
number (NHI)- it allows easier tracking of information
through healthcare episodes.

85. All information collection, storage, access and
retrieval in New Zealand is governed by the
Privacy Act (1993) and the Health Information
Code (1994)
*This act is one of the most comprehensive pieces
of privacy legislation anywhere in the world.

86. New Zealand Health Informatics Groups
Ministry of Health (MoH) – plays an important
role for the formal intra- and intergovernment
liaison work it undertakes, it’s influence on sector
policy and strategy, and it’s funding capability.
Health Informatics New Zealand (HINZ) – a
national, non-profit organization whose focus is to
facilitate improvements in business processes and
patient care in the health sector through the
application of appropriate information
technologies

87. Technological Trends
The health environment is changing at an ever-
increasing pace due to the proliferation of new
and emerging technologies.
Embracing the advances in technology enable us
to deliver healthcare in new and innovative ways.
New Zealand has been embracing these
changes in technology and has particularly
benefited from the development of infrastructure.

88. Some Trends in Technology
1. Higher speed networks including wireless and
broadband are enabling information in a variety
of formats to be shared. Digital images are
becoming the norm as well.
2. Improvements in portabillity are now allowing
the use of technology in greater range of
settings. Examples are the personal digital
assistants (PDA) and tablets

89. 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
Informatics” curriculum was introduced into the
undergraduate preparation of nurses programs.

90. HEALTH AND NURSING INFORMATICS IN 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.
Australia has more than 50 such specialty national
nursing organization (NNOs),where the Health
Informatics Society Australia’s nursing
informatics special interest group (HISA NI Sig).

91. HISA NI Sig has been funded to develop a
strategic plan for NI capacity building ,and a plan
for the nsg. profession’s engagement with
the Australian government and its informatics
agenda.
Nov.2003 Australian Health Minister’s
Conference was announced that a national nsg.
taskforce would be established to drive major
nsg.education.

92. NURSING INFORMATICS IN HONG KONG
NURSINFO(HK)Ltd.-established by Hong Kong nurses , and this organization has
enjoyed a consistent increase in membership.
Hong Kong nurses have a motto and that is, “NURSING INFORMATICS FOR
EXCELLENCE IN PATIENT CARE”.

93. The Hong Kong Hospital Authority is responsible
for over 40 hospitals and over 50 specialist clinics
that are part of a large multisite, multiprotocol
intelligent data network to provide seamless data
communication.
Implementation began in 1993.Telemedicine and
videoconferencing are in use and multimedia
enhancement in the clinical setting with voice
recording and imaging now helps to speed up the
works process and strengthens services in clinical
areas.

94. THAILAND
The country has a population of about 65 million living in 76 provinces. The
government is currently launching a Universal Healthcare Coverage policy in order to
improve the access to and quality of healthcare, as well as to contain healthcare
expenditure.

95. The Development of a Health Information System
In 1997, the Thai MOPH began to implement a
national health information system, which
included the development of a nursing
component.
Funding was received from the WHO 1999 as a
result of a collaborative effort between the Center
for Nursing research at the Department of
Nursing, The Faculty of Medicine, Mahibol
University, and the MOPH Nursing Division to
develop the ideal nursing minimum data set and a
preliminary nursing classification system.

96. THANK YOU 