The health industry faces many challenges—because the health sector is complex and fragmented, involves multiple levels of government, numerous individuals and a large number of private sector organisations. Health services are becoming more expensive, and the demand on health services is growing due to factors such as the ageing population, the increasing burden of chronic disease, and the costs of new methods of diagnosis and treatment (Armstrong et al., 2007 and Conrick, 2006).

In a report by the Australian Department of Finance and Administration (2006), national spending on information and communication technology (ICT) is about $5 billion a year, while ICT expenditure in the Australian healthcare industry is estimated at $2 billion per year, which seems to be an indication by government policy makers that ICT is a useful resource in efforts to improve patient care and deliver quality health outcomes (Conrick et al 2004). Automation has much to offer healthcare workers and, indeed, the last ten years have seen the beginnings of a transformation in healthcare, triggered by a rapid rise in the use of information technology across all areas of healthcare and the rapid increase in the sophistication of information systems. While health administration was an early adopter of information technology, and new technology for diagnostic and treatment purposes is becoming commonplace, investment in systems and strategies to support clinicians lags well behind. Clinicians usually have to navigate myriad paperwork and often make decisions based on fragmented and poor-quality data.

There is potential for information technology to be used for the storage and delivery of health information, especially between clinicians, which in turn may contribute to better patient outcomes and reduction in errors, by delivering timely clinical information quickly and at the point-of-care in a form that can be read and understood. It also empowers clinicians by providing them with the tools of evidence-based decision making, with the deployment of knowledge databases and information repositories. Leonard et al (2004) suggest that information technology has the ability to address the communication failures that account for approximately 70% of causes of sentinel events reported to the Joint Commission for Hospital Accreditation. In retrospect, however, caution should be taken with the use of ICT, as some reports have emerged which suggest that the risk of errors (such as in medication prescribing) could increase in some circumstances due to inaccurate data entry (Magrabi et al 2007).

The benefits of SMS in the healthcare sector are very promising. In the United Kingdom, the National Health Service sends routine SMS to patients to make them aware of visits, follow-up or changes to appointments. According to work reported in Australia by Downer et al (2005), SMS reminders sent to patients prior to their scheduled outpatient appointment has a similar impact to standard telephone reminders, but was much more economical due to the ability to send large volumes of customised messages in one instance.

This chapter expands health professionals’ awareness of informatics as a tool for clinical practice and discusses the major issues for nursing in its uptake. It will expand readers’ awareness of the use of technology in the collection, use and sharing of digitised health information. There are many branches of health informatics, but it is predominantly nursing informatics that will be perused in this chapter. In such a complex discipline, it is not surprising for confusion in nomenclature to arise and it is pertinent here to discuss the common terms of e-health and health informatics.

The term nursing informatics was introduced into the nursing profession in the late 1980s in alliance with the many technical advances that have been reported to date. Among the definitions, a widely accepted definition is that of the Nursing Informatics Specialist Group of the International Medical Informatics Association (IMIA–NI). According to the IMIA–NI, 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’ (Conrick 2006:5). Other terms that are also sometimes associated with informatics but are used to describe the use of communication technology in healthcare are telemedicine, telehealth and e-health.

Telemedicine refers to the delivery of ‘medical’ services across a distance using a range of communication techniques, such as telephone, email and videoconferencing (Smith 2007). With recent advances in all areas of healthcare, including medical, nursing and allied health, a more general term ‘telehealth’ has often been adopted (see Ch 16). Despite this, there are always new terms being introduced that are often a cause for confusion. The introduction of yet another term (i.e. ‘e-health’) seemed to be in response to the growth of internet (web-based) services and exploitation of information technology in the healthcare sector.

‘E-health’ is defined by the World Health Organization (2008) as the use, in the health sector, of digital data—transmitted, stored and retrieved electronically— in support of healthcare, both at the local site and at a distance. It refers to the healthcare components delivered, enabled or supported through the use of information and communications technology. Examples include clinical communication systems such as online referrals, e-prescribing and electronic health records. E-health is identified as a platform for remote health service delivery, patient-centred care, supported self-care, remote access and monitoring, and health system sustainability.

Health informatics is an evolving sociotechnical and scientific discipline that deals with the collection, storage, retrieval, communication and optimal use of health-related data, information and knowledge. The discipline utilises the methods and technologies of the information sciences for the purposes of problem solving and decision making—thus, assuring quality healthcare in all basic and applied areas of biomedical sciences for the community it serves (Health Informatics Society of Australia 2007).

In healthcare, the use of information technology has caused some debate, some of which has been quite passionate. In time, we suspect that parallels will be drawn with the following quote, and healthcare workers might then wonder what the fuss was all about:

Nurses focus on patients’ responses to illness, injury, treatment and care within the context of the patients’ family, social structure and location (Conrick et al 2004). In addition, their services are guided by patient risk assessments, which form the basis of preventative nursing interventions. These assessments and interventions include the broader health context of psychosocial, environmental and family/carer considerations, and are crucial to the ongoing health of our community. Nurses are the only professionals who work across health transitions and therefore the continuum-of-care. To effectively and efficiently engage with patients and clients across such diverse practice areas, nurses must use the most efficient and effective tools available to them, and technology is able to provide many of these.

Nurses are found in a diversity of practice areas and geographical settings supporting an increasingly transient community. This is an increasing challenge, particularly in rural and remote Australia, where they (nurses) are often isolated from other practitioners and must, by necessity, practise alone. The fragmented records of care and inadequate methods of communication are a major issue. Information technology has the potential to support clinicians by providing timely, quality data, and to largely negate the tyranny of distance, through high-speed broadband and satellite access. This is the domain of nursing informatics.

Nursing informatics may be defined as:

As information technology permeates nursing, all nurses must have a working knowledge of informatics and understand what it offers the profession. Nursing input is essential in the development of information systems, and anecdotal evidence suggests that it is a significant factor in the success or failure of these systems.

The International Standards Organization defines data as the representation of real-world facts, concepts or instructions in a formalised manner suitable for communication, interpretation or processing by human beings or by automatic means (International Standards Organization 1999). Information builds on data and is the output of the data interpretation, organisation and structure (Standards Australia 2003). When information has been synthesised, interrelationships are identified and formalised knowledge is created (Standards Australia 2003). The evidence for use as clinical information and nursing knowledge result from the progressive cognitive or automated processing and manipulation of data, language and knowledge, and in turn governs it. Nurses are recognised as the key collectors, generators and users of patient/client data and information, and the delivery of good nursing care is dependent upon the quality and timeliness of the information available (Currell et al., 2002 and Hovenga and Hindmarsh, 1996a).

According to Mercer (2003), there are three levels at which the collection of digitised health information can be used and shared. The first level is the service delivery level and most data are generated here (see Fig 22.1). At this level, computer systems capture initial patient care data, but may also exchange data between different systems (e.g. a referral could be generated from the hospital to a community service or from one program to another). Data from this level also form the basis of population surveys. National standards operate here to ensure quality and clean data collection. Mercer describes the second level as the intermediate level, saying that:

The volume of data reported to the intermediate level will normally be less than the data generated at the service delivery level because not all data that are generated need to be reported. Data may also be aggregated for reporting, or may be reported in the form of individual records for each patient or client.

In the final level, or the national level, data from intermediate levels, or at times directly from the service delivery level, may be reported to national data collection agencies. Alternatively, data from census or surveys may be collected at this level, using data captured from the service providers, patients/clients or the general population (Mercer 2003). Data from intermediate levels, or at times directly from the service delivery level, may be reported to national data-collection agencies, the third level of use and sharing. Alternatively, data from census or surveys may be collected at this level, using data captured from the service providers, patients/clients or the general population. From this it is easy to realise that a breakdown of data collection in any stage has far-reaching ramifications for health.