Unit – 8

NURSING INFORMATION SYSTEMS

INTRODUCTION:
• Health care is delivered in dynamic, complex, and ever changing environments.
• Changes in medical treatments, regulations for federal and state reimbursement and public
knowledge about making individual and collective health care choices create growing demands
for information.
• To respond proactively for these changes and the growing demands for clinical information,
computer systems are being devised to collect, store, retrieve, analyze and communicate health
status and health care information.
• Appropriately designed and deployed computerized systems of information can transform
patient care data into clinically relevant and useful information and knowledge.
• A nursing information system (NIS) is a specialized type of healthcare information system
that is designed to support the nursing profession and the delivery of nursing care.
• The primary goal of an NIS is to provide nurses with the tools and information they need to
efficiently and effectively manage patient care.
IMPORTANCE OF NURSING INFORMATION SYSTEMS
The components of a healthcare information system allow for
• Clinical and health management decision making
• provide for input of information from the clinical sciences (medicine, pharmacy, dentistry,
nursing, allied health and rehabilitation) as well as from the management, behavioral,
information and communication sciences.
• The role of information sciences in medicine continues to grow, and the past few years have
been informatics begin to move into the main stream of clinical practice. The scope of this
field is, however, enormous. Informatics finds application in the design of decision supports
for practitioners, in the development of computer tools for research and in the study of the very
essence of medicine its corpus of knowledge.
Definitions
• Hospital Information System are computer-based software applications that integrate many
medical, nursing, and administrative and miscellaneous functions of hospitals. It combines
computer technology and communications to acquire and integrate financial and clinical data.
• Nursing Information System is a part of a health care information system that deals with
nursing aspects, particularly the maintenance of the nursing record.
PURPOSE OF NURSING INFORMATION SYSTEMS
1. To make relevant patient data available in a usable form so patient care problems can be solved
2. To process information to support management functions such as receiving data from
departments and supplying data to departments to make policy decisions, operating decisions
as well as patient care decisions
3. To provide a comprehensive automated information processing system for all phases of the
nursing process
4. To develop care plan for families and patients
COMPONENTS OF NURSING INFORMATION SYSTEMS
1. Hardware: Physical devices that provide handling function such as input, CPU, processing,
storage or output of computer data.
2. Software: Series of programming statements that perform a specific computer related
application; categories include systems, operating, application and programming (word
processors, spreadsheets, databases, multimedia applications and communication programs).
3. Network: Devices and software applications that provide communication and data transfer
between 2 or more computer systems. There are three types of networks:
A. Wide- Area Networks (WAN): Are links to the outside world. They connect computer
users to other users and systems through the telephone company’s communication
infrastructure. WAN support voice, data and image transmission.
B. Local- Area Network (LAN): Are used to connect user’s within a local, somewhat
defined, geographic area such as a building or closely grouped set of buildings.
C. Wireless networks connect information system: Uses computer and communication
hardware using wireless transmission of data, example electrocardiogram and cell phones
An NIS typically includes a variety of functions and features, including
1. Electronic health records (EHRS),
2. Computerized physician order entry (CPOE),
3. Clinical decision support systems (CDSS),
4. Other tools to help nurses with tasks such as
• Medication administration,
• Care planning,
• Patient monitoring.
5. These systems are often integrated with other healthcare information systems, such as
laboratory information systems (LIS) and radiology information systems (RIS), to provide a
comprehensive view of patient data.

EXAMPLES OF NURSING INFORMATION SYSTEMS

1. A System (EmSTAT) at Hennepin County Medical Center (Minnaeapolis, Minnesota)
improves communication, facilitates continuity of care and decreases redundancy in
documentation.
2. The Nursing Case Management Computerized System – an interactive computer
program that enhances team planning of individualized care, decreased paperwork, aided
the development of team care plans and facilitated improvements in the quality of patient
care.
3. The Interactive Home Health Care systems- provide for audio and video interactions
over local cable systems, as well as patient monitoring and data input and retrieval by the
nurse.
4. NurseLink – an electronic bulletin board operated by the School of Nursing at the
University of Colorado Health Sciences Center in Denver.
5. An Expert system – developed to assess pregnant women’s risk of preterm birth.
TIPS TO DEVELOP NURSING INFORMATION SYSTEMS
1. Choose software first
 2. Request software information from several vendors
3. Provide vendor with pertinent information about size of agency, number of departments,
type of departments and number of patients
4. Provide information about the capabilities of the system users
5. Provide information about other computerized systems within the organization
6. Have the planning committee make a site visit to an organization where the selected
software has been used
7. Observe use of software in a similar organization
8. Have vendor install, maintain and duplicate system information and train personnel
9. Have vendor phase out former system
NURSING INFORMATION SYSTEMS VS EMERGING ROLES OF NURSES
Advances in information technology emphasized the need for all nurses to:
1. Involve information from assessing the health care needs of patients
2. Developing care plans
3. Communicating patient information to other health professionals
4. Analyzing staffing and budget reports-in fact, nurses work in a information-intensive
environment
5. Become more knowledgeable about health information concepts and the technology that is
designed to manage and process information
6. As technology continues to evolve, nursing practice methods will also adopt to take
advantage of automation
7. Nursing professionals will move frequently have key roles in integrating technology into
patient care delivery
8. Nurses make excellent information systems people because they are data gathers and
documenters, have global systems views, set priorities, manage all care and understand the
need to access patient information

ISSUES RELATED TO UTILIZATION OF NURSING INFORMATION SYSTEM

1. Unfortunately, until recently nursing as a profession was not sufficiently involved in the
selection, implementation and decision making regarding what systems are best for
institutions, as a result many of the earlier systems in the market place and in hospitals have
not met nursing needs.
2. It is impossible to introduce nursing informatics into an organization without the people in that
organization feeling the impact of change.
3. Despite the benefits nursing informatics have to offer they are not widely used in health care
and where they have been installed, they have not been readily accepted – it could probably
due to lack of adequate training and failure to educate the end user what the reasons for its
introduction
4. Very little research has been done to determine the cost benefits or cost effectiveness of
information systems
5. Hypothetical future situations pose challenges related to current nursing informatics and
artificial intelligence issues.
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ADVANTAGES
1. helps improved nurses’ documentation… Proper clinical documentation is very significant
in every health care system, and without NIS providing an easy way to record all the necessary
data, in a systematic and uniform way, and then it would be difficult for the institution and
staff that would affect patient care and services. Data may include from the drugs to be
administered and their dosage and time; schedule of medical tests and their results to relevant
vital parameters of the patient like daily records of body temperature, blood pressure, and
among others. NIS helps reduce the need for redundant paperwork, as well as enables
maintaining patient history that can be easily accessed whenever required.
2. It helps in overall better staff management…Having Nursing Information System helps
provides an efficient way to handle administrative activities such as workload management,
maintaining staff records, as well as scheduling shifts, among others. It also helpful for nurse
administrators in assessing staffing requirements, as well as financial management through
budgeting and monitoring of expenses.
3. It helps in having an efficient decision-making…There are features of NIS which enable
information management and decision-making through active and passive systems. Passive
systems are able to organize and format the data according to preset parameters, and provide
parameter-specific information, as and when required. Active systems on the other hand, are a
step advanced and suggest diagnoses on the basis of predefined criteria applied to the patient
information.
4. It is a way to enhance synchronization - In nursing, patient data generated in all units is
always essential and significant for the decision-making in any unit of a medical facility. This can
be better achieved through the integration of NIS with other clinical systems, which enables fast
and easy access of the documented information to all the appropriate units.
HEALTH CARE DATA MANAGEMENT
Health Data Management
• Health Data Management (HDM), also known as Health Information Management (HIM) is
the systematic organization of health data in digital form.
• This can be anything from Electronic Medical Records (EMR) generated as a result of doctor
visits, to Electronic Health Records (EHR), to handwritten medical notes scanned to a digital
repository.
• Health Data Management is tasked not only with organizing medical data but also integrating
it and enabling its analysis to make patient care more efficient, and derive insights that can
improve medical outcomes, while protecting the privacy and security of the data.
According to a Deloitte survey:
• Most healthcare organizations collect EMR abstracts, claims data, and data about enrollment
and medical programs.
• Only leading organizations additionally use electronic EMR feeds and disease management
program data.
• Very few organizations use non-health data sources that can be used to augment formal
medical data, such as patient lifestyle information, remote monitoring and wearable devices,
and survey data about patient experience.
Health Data Management Benefits
Health Data Management can have significant benefits for healthcare organizations, medical staff
and patients:
1. Create a comprehensive view of patients, households, and patient groups—composite
profiles that provide status and enable predictions.
2. Improve patient engagement—target patients with reminders and care suggestions that can
be relevant for them, based on predictive modeling.
3. Improve health outcomes—track health trends in certain areas or among specific populations,
predict new trends and suggest proactive measures to counter rising health issues.
4. Business decision making—help healthcare providers make better data-driven decisions, such
as which types of medical professionals to recruit, what equipment to invest in, or which types
of patients to focus on in marketing efforts.
5. Analyze physician activity—analyze data on medical practitioners such as success rates, time
invested in different treatments and medical decisions, and aligning physicians with the goals
of the healthcare organization.
Three Health Data Management Challenges
In the past forty years, medical data began a transition from purely paper-based tracking to
digitized information. Even today, many types of medical data have yet to be digitized, or have not
yet been integrated into Health Data Management systems.
Here are a few important challenges facing health data professionals today:
1. Fragmented data—medical data can be structured data in spreadsheets or databases, images
or video files, digital documents, scanned paper documents, or may be stored in specialized
formats such as the DICOM format used for MRI scans. Data is widely duplicated, collected
multiple times and stored in different versions by healthcare providers, public health
organizations, insurance bodies, pharmacies, and patients themselves. There is no one source
of truth for information on patient well being.
2. Changes to data—medical data constantly changes as do the names, professions, locations
and conditions of patients and physicians. Patients undergo numerous tests and are
administered many types of treatment over the years, and the treatments and medications
themselves evolve over time. New types of medical treatment, such as telehealth models, create
new types of data.
3. Regulations and compliance—medical data is sensitive and must adhere to government
regulations, such as the USA Health Insurance Portability and Accountability Act (HIPAA).
Data discovery challenges and poor data quality make it much more difficult to perform the
required audits and meet regulatory requirements and limits the diversity of data healthcare
providers can use for the benefit of patients.
Storage Considerations for Healthcare Data
According to research from IDC, the amount of data generated by healthcare information and
imaging systems is expected to grow from 153 Exabytes in 2013 to 2,300 Exabytes in 2020.
Beyond the above challenges, healthcare providers need to consider how they will store all that
data:
1. Scalability—the fastest-growing segment of healthcare data is unstructured data such as
MRIs, CT scans, X-ray and PET scans. As this data grows to Petabytes, healthcare
organizations need a highly scalable, low-cost storage solution.
2. Compliance—storage must be compliant with regulations. HIPAA and other healthcare
industry regulations require that data be protected with Role-Based Access Controls (RBAC),
audit trail logging and data encryption at rest and SSL for data in transit, with properly-
audited key management procedures.
3. Vendor neutral archive (VNA)—a VNA provides one interface for multiple healthcare
information platforms. It makes it easier to consolidate many types of healthcare information
into a central repository that provides a central view of patient records. Storage platforms
should provide VNA integration.
4. Data resiliency and protection—health data is a frequent target for cyberattacks and
represents a major risk for providers if it is accidentally lost or deleted. Storage systems should
provide redundancy, replication, data backup, and erasure coding that can distribute
fragments of data across multiple nodes.
Health Data Management (HDM) is the methodical organization of health data in digital form.
This can be anything from Electronic Health Records (EHR), Electronic Medical Records (EMR)
generated as a result of doctor visits, to handwritten medical notes.
Health Data Management enables you to integrate and analyze medical data to make patient
care more efficient, and extract insights that can improve medical outcomes, while protecting the
security and privacy of the data.
Medical Records Retention: Understanding the Problem
Every person in the developed world has a medical record. Medical records collect valuable and
sensitive information about the health of an individual. This includes their well being, medical
conditions they suffer from and required medical treatments.
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HEALTH CARE DATA

Health care data refers to information related to the health of individuals, populations, and the
performance of health care systems. This data is vital for medical research, clinical decision-
making, public health planning, and the overall improvement of health care services. Health care
data can be categorized into various types:
1. Electronic Health Records (EHRs):
2. Health Insurance Claims Data:
3. Clinical Trials Data:
4. Public Health Surveillance Data:
5. Genomic Data:
 6. Medical Imaging Data:
7. Patient-Generated Health Data (PGHD):
8. Administrative Data:
HEALTHCARE DATA MANAGEMENT
Healthcare data management refers to acquiring, storing, organizing, and utilizing data from
clinical sources such as
EHRs, labs, pharmacies, and more, or non-clinical sources such as public databases,
wearable devices, and more
BENEFITS FROM EFFECTIVE DATA MANAGEMENT:
Use of health care data in the management of health care organizations is following
1. Improved Patient Care: Holistic data management can empower providers to access
comprehensive and accurate patient information, including medical history, medications,
allergies, and test results. This can significantly improve clinical decision-making, drive
accurate diagnoses, and enable personalized treatment plans by leveraging unified data as a
single source of truth to coordinate among multiple healthcare providers involved in a patient's
treatment.
2. Enhanced Patient Safety: Data management systems can reduce the risk of medical errors
and adverse events. If managed and updated on a regular basis, it can facilitate access to
complete and up-to-date patient information, including medication records and allergies that
can help in patient identification, prevent medication errors, and any risk due to allergic
reactions.
3. Operational Efficiency: Streamlining data management processes can improve efficiency in
healthcare organizations by multiple folds. Electronic health records (EHRs) and digital
documentation eliminate the need for paper-based records, reducing administrative burden,
storage costs, and the risk of lost or misplaced records. Automating tasks such as data entry,
appointment scheduling, and billing can improve workflow efficiency allowing providers to
focus more on patient care.
4. Population Health Management: Healthcare data management lays solid groundwork for
deep analysis of aggregated and de-identified data to identify health trends, disease patterns,
and population health risks. The insights can help providers develop preventive strategies,
implement public health interventions, and allocate resources for specific communities or
regions.
5. Clinical Research and Evidence-Based Medicine: Healthcare organizations can support
their clinical research by providing access to comprehensive and diverse datasets for analysis
and studies. Researchers can use high-quality data to identify potential research participants,
conduct epidemiological studies, evaluate treatment outcomes, and develop evidence-based
guidelines and protocols.
6. Healthcare Policy and Planning: Private and public healthcare organizations can leverage
aggregated data to support the policy development process, and strategically allocate
resources for scalable healthcare planning at the regional, national, and global levels.
Healthcare databases on disease prevalence, healthcare utilization, and outcomes can inform
policy decisions, public health strategies, and resource allocation for healthcare
 infrastructure, workforce, and interventions for chronic conditions or during pandemic
outbursts such as COVID-19.
7. Compliance and Privacy: Cloud-native data management systems ensure compliance with
privacy and security regulations, such as HIPAA in the United States. Healthcare
organizations managing data operations in private data centers can protect patient
information, maintain confidentiality, and prevent unauthorized access or breaches by
implementing appropriate security measures, data encryption, access controls, and audit
trails.

The effective use of health care data in management contributes to evidence-based decision-
making, continuous improvement in patient care, and the overall success of health care
organizations. It allows for a data-driven approach to addressing challenges, optimizing
resources, and enhancing the delivery of health care services.
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REFERENCES

1. https://ajner.com/HTMLPaper.aspx?Journal=Asian%20Journal%20of%20Nursing%20E
ducation%20and%20Research;PID=2012-2-2-6
2. https://cloudian.com/guides/hipaa-compliant-cloud-storage/health-data-management/
3. https://innovaccer.com/glossary/healthcare-data-management