What is health informatics?

The increasing reliance on information in all areas of health care is well documented (Bowles & Teale 1994; Coiera 1998; Matthews & Newell 1999; Smaltz 2001). Information is a key resource, its availability and relevance is directly related to the quality of health care. The term ‘informatics’ has its foundations in the French word ‘informatique’ (Strachan 2002). Health informatics is broadly defined as the use of IT, telecommunications and computers in health care to improve patient care, communication, research and education. Further, it encompasses processing of data and information and knowledge management for use in health care delivery. Terminology is used to describe the different types and functions of the technology. The delivery of health care information, products and services over the Internet is defined as Web-based health, or e-health. The data is digital and is transmitted, stored, accessed and retrieved electronically for clinical, educational and administrative purposes, both locally and at a distance. Other terms, such as telemedicine or telehealth, are used to refer to the remote provision of consumer care, education and public health.

As the cost of the technology and its more ‘user friendly’ approach have evolved, its adoption in health has accelerated. The implications for health care workers are considerable. To use information systems appropriately there needs to be fairly radical changes to the implementation standards for both data access and data manipulation. Information skills are basic for all health care workers. They need to be educated to use information tools to manage information and create knowledge, as well as trained in the use of information systems and data analysis. Clinicians, in particular, need both computer and information literacy skills to understand the principles of data interpretation and the management of clinical knowledge (Coiera 1995).

Defining nursing informatics

The term ‘health informatics’ has been used to include all health care professionals; however, both medical and nursing informatics are used extensively in the literature.

Nursing informatics has been defined by a number of experts in the field. Earlier definitions included:

Hannah: ‘nursing informatics is the use of information technologies in relation to any function which are within the purview of nursing and which are carried out by nurses in the performance of their duties’ (1985, p.181);

Grobe: ‘the application of the principles of information science and theory to the study, scientific analysis, and management of nursing information for the purposes of establishing a body of nursing knowledge’ (1988, p.29); and

Graves and Corcoran: ‘a combination of computer science, information science and nursing science designed to assist in the management and processing of nursing data, information and knowledge to support the practice and delivery of nursing care’ (1989, p.227).

More recent definitions include:

Goossen: ‘the multidisciplinary scientific endeavor of analysing, formalising and modeling how nurses collect and manage data, process data into information and knowledge, make knowledge-based decisions and inferences for patient care, and use this empirical and experiential knowledge in order to broaden the scope and enhance the quality of their professional practice’ (1996, p.187); and

American Nurses Association: ‘a specialty that integrates nursing science, computer science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information and knowledge support patients, nurses and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology’(2001, p. vii).

Who leads the charge?

Throughout its history the nursing profession has been responding to changing educational, social and technological forces. The current wave of technological changes present additional challenges to the profession, particularly to nurse leaders. Currently available technology is capable of meeting the information, knowledge and communication needs of all health care stakeholders.

Nurse leaders need to set goals and champion the cause. Goals can relate to:

organisational readiness;

advancement of a service learning culture;

change; and

benefits.

Information management can be defined as ‘the art and science of using standard health care data to answer clinical and managerial questions’ (Diers & Pelletier 2001 p.74). Development of information literacy skills supports evidenced-based practice. Such skills include the recognition of the requirement for information, critical appraisal of information and applying information to a given clinical problem.

Scope of the challenges

The challenges facing the health care system includes clinicians not only mastering the technology, but accepting those technological advances that can improve the quality of patient care. The National Health Service in the United Kingdom recommends health informatics training for all clinicians. The recommendations highlight common elements of clinical practice relevant to all health care workers, including communication, knowledge management, data quality and management, confidentiality and security, clinical and service audit and telehealth. Research is fundamental to all stages of information and technology uptake, both for assessing the needs and evaluating the outcomes. Therefore, research pays an essential role in the adaptation and implementation of technological changes. The American Organisation of Nurse Executives (AONE) believes that nurse leaders guide such adaptation and implementation of technology changes. They have proposed the following categories for technology research priorities:

technology adaptation (patient and staff outcomes from use of technology);

systems improvement (infrastructure changes to accommodate new technology);

utilisation of information technology to promote continuous learning (for health professionals and consumers);

designing, implementing, and evaluating electronic patient information systems and an electronic patient record (attention to nursing practice and outcomes utilisation of a standardised nursing language, assuring nursing interventions, and outcomes are included in the electronic patient record); and

the impact of the Internet (on consumers and professionals)(Goode 2001).

Health care environment

In the changing health care environment, nurse leaders are constantly challenged to decrease costs and measure quality outcomes. In the United Kingdom, the United States and Australia the response has been to restructure traditional care delivery systems and practice patterns at all levels of primary and tertiary care. Each country has approached this from a different perspective. Managed care has been a fundamental constituent in all approaches. The managed care concept embraces systems of health care delivery that manage three things: resources, quality of care and access to health care. Key elements of any form of managed care include capitation, clinical pathways, measuring outcomes and coordinated care. The coordination of care can be either by an individual or group of individuals, termed case managers.

Models of care and technology

Nurse case managers are required to have knowledge of, and influence over, the application of technology and information systems (Coile 1999). Areas that need improvement to support communication, documentation and outcomes reporting include information management and software support (Zerull 1999). The evidence from long-term management of chronic illness and prevention or early identification of disease among high-risk populations indicates a major role for information technology applications. Coile (1999, p.244) contends that communication and information technologies connect case managers with high-risk and chronically ill patients, enabling them to harness optimal software, such as care management software, expert systems and remote monitoring. Case managers deal with multiple and diverse information sources, and an increasing demand on them to be competent in managing data, data exchange, use of area networks and the Net/Web (Ball 2000).

Maehling and Badger (1996) raise the question of whether emerging clinical systems and software meet the various needs of a case manager. Functions integral to the role that require computer systems support include the five categories: patient profile; history of encounters; current and past diagnosis—problem list; plan of care; and expected outcomes. The increasing use of clinical pathways as a means of documenting and managing delivery of care, presents a challenge to most vendors. Maehling and Badger contest that software vendors struggle with co-morbidities and the merging of clinical pathway elements to meet unique patient-specific conditions. They suggest the most important clinical pathway application functions are automation of both standardised and customised multidisciplinary clinical paths (individualised modifications), ability to handle co-morbidity and/or combine carepaths, ability to track and analyse path variance, decision support capabilities and integration with clinical documentation (Maehling & Badger 1996).

Clinical documentation in itself poses another problem. Several methods of documentation are currently in use by different health care professionals. These range from narrative documentation to a system called Problem-Oriented Medical Record, a way of organising the description of patient care according to an acronym—for example, SOAP—Subjective, Objective data, the Assessment, and Plan (Williams 1998). Physiotherapists (physical therapists) often use SOAP and other health care professionals use a variation of the PIE system (Problem, Intervention and Evaluation). Williams outlines some of the requirements for computerised documentation systems for case managers, such as: keeping information in more than one format (both forms and narrative capabilities); allowing adequate computer memory for copious amounts of data; having the capacity to document, archive and retrieve information, and readily provide cost-related information.

Information technology solutions that can improve clinical processes have existed for some time. Few organisations have had the resources to explore the potential that such technologies provide at the clinical level. Such patient safety technologies include:

risk management—records and analyses adverse events;

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