What is Informatics?

Chris Curran, PhD, RNM8120September 4, 2001

Goethe, 1810

The modern age has a false sense of superiority because

it relies on the mass of knowledge that it can use,

but what is important is the extent

to which knowledge is organized and mastered.

Terms

Medical InformaticsHealthcare InformaticsNursing Informatics

Goal of Nursing Informatics

“The goal of nursing informatics is to improve the health of populations, communities, families and individuals by optimizing information management and communication. This includes the use of technology in the direct provision of care, in establishing effective administrative systems managing and delivering educational experiences, supporting life-long learning and supporting nursing research.”

Source: ANA. (2001, proposed). The Scope of Practice of Nursing Informatics and the Standards of Practice and Professional Performance for the Informatics Nurse Specialist

First Definition: Nursing Informatics

“The application of computer technology to all fields of nursing—nursing service, nurse education, and nursing research.”

(Scholes and Barber, 1980, p. 70)

Definition: Nursing Informatics

Nursing informatics is a combination of nursing science, information science, and computer science to manage and process nursing data, information and knowledge to facilitate the delivery of health care.

(Graves & Corcoran, 1989)

Definition: Nursing Informatics

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. Nursing informatics facilitates the integration of data, information and knowledge to 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 and information technology.

Source: ANA. (2001, proposed). The Scope of Practice of Nursing Informatics and the Standards of Practice and Professional Performance for the Informatics Nurse Specialist

Definition: Medical Informatics

The scientific field that deals with biomedical information, data and knowledge-their storage, retrieval, and optimal use for problem-solving and decision-making.

(Shortliffe & Perreault, 2001)

The Metastructures, Concepts, and Tools of Nursing and Nursing Informatics

Nursing Nursing Informatics

Nurses, patients, health, environment

Nursing data, information, and knowledge

Content of information Design, structure and presentation of information as it impacts nurses’ decision-making

Using information applications and technology

Optimizing information structures, applications and technology for use in managing and communicating data, information and knowledge

Source: ANA. (2001, proposed). The Scope of Practice of Nursing Informatics and the Standards of Practice and Professional Performance for the Informatics Nurse Specialist

What Informatics is Not…

Synonymous with computer technology

Facts

Recognized as a specialty for registered nurses by the American Nurses Association in 1992.

Computers can’t…but Humans can…

Perceive data and informationAbstract data and informationMake decisions that involve values and risk preferences

Scope of Informatics

Data, information, knowledge and wisdomCommunication and information managementTypes, capabilities, and limitations of technologyLegal and ethical considerations of information

Key Concepts

DataInformationKnowledgeWisdomKnowledge WorkersDecision MakingInformatics CompetenciesWorkflow

TechnologyHardwareSoftware Electronic StandardsSystem ArchitectureInternet / WWWDatabase

Data, Information and Knowledge

(Blum, 1986)

Data are discrete entities that are described objectively without interpretation,Information is data that are interpreted, organized, or structured, and Knowledge is information that is synthesized so that relationships are identified and formalized

Wisdom

Wisdom is the appropriate use of data, information and knowledge in making decisions and implementing nursing actions.

Knowledge Workers

Definition: Knowledge work is non-repetitive, non-routine work consuming considerable levels of cognitive activity (Drucker, 1993).

Bring their knowledge, skills, judgment, and time to the organization

Information Processed: Quantity vs. Quality (Patel, 1997)

RelevantInformation

InformationProcessed

Novice Intermediate Expert

Decision Making

Models Information Processing Decision Analysis Skill Acquisition

UncertaintyBiases

Decision Making

Process vs OutcomeCritical Thinking vs Decision Making

Workflow

Process MappingLow Level vs High Level Processes

Systems Architecture

IntegratedDistributed

Overarching Standards of Practice

for the Informatics Nurse Specialist

1. Incorporates theories, principles and concepts from appropriate sciences into informatics practice such as information, systems, and change theories; implementation methods, organizational culture, and database structures.

2. Integrates ergonomics and human-computer interaction principles into informatics solution design, selection, implementation and evaluation. 

3. Systematically determines the social, legal, and ethical impacts of an informatics solution within nursing and health care.

Source: ANA. (2001, proposed). The Scope of Practice of Nursing Informatics and the Standards of Practice and Professional Performance for the Informatics Nurse Specialist

Informatics Nurse Specialist Standards of Practice

Standard I. Identify the Issue or ProblemStandard II. Identify Alternatives Standard III. Choose and Develop a

Solution Standard IV. Implement the SolutionStandard V. Evaluate and Adjust

Solutions

Source: ANA. (2001, proposed). The Scope of Practice of Nursing Informatics and the Standards of Practice and Professional Performance for the Informatics Nurse Specialist

Informatics Nurse Specialist Standards of Professional

Performance

Standard I. Quality of Nursing Informatics Practice Standard II. Performance Appraisal Standard III. Education Standard IV. Collegiality Standard V. Ethics  Standard VI. Collaboration Standard VII. ResearchStandards VIII. Resource Utilization Standard IX. Communication

Source: ANA. (2001, proposed). The Scope of Practice of Nursing Informatics and the Standards of Practice and Professional Performance for the Informatics Nurse Specialist

Theoretical Models

Schwirian (1986)Graves & Corcoran (1989; 1995)Staggers and Parks (1993)ANA Scope and Standards Document (2001)

Schwirian Model (1986)

NI Activity

Goal

Information

Computer

Hardware

Software

Context

User

Source: Schwirian, P. M. (1986). The NI pyramid-A model for research in nursing informatics. Computers in Nursing, 4(3), 134-136.

Graves and Corcoran Model

(1989; 1995)

Data

Information

Knowledge

Decisions

Designs

Discoveries

Literacy Management

Informatics (structure and transformation)

Source: Graves, J. R., Amos, L. K., Huether, S., Lange, L., & Thompson, C.B. (1995). Description of a graduate program in clinical nursing informatics. Computers in Nursing, 13(2), 60-70.

Staggers and Parks Nurse-Computer Interaction Framework (1993)

Computer Characteristics

Computer Interface Options

Nursing Context

Nurse Characteristics

Nurse Behaviors

Initiate

Respond

TaskInformation ExchangeTime

Nursing Informatics Development Trajectory

Source: Staggers, N. & Parks, P. A. (1993). Collaboration between unlikely disciplines in the creation of a conceptual framework for nurse-computer interactions. In M. E. Frisse, (ed.). Proceedings of the Sixteenth Annual Symposium on Computer Applications in Medical Care, NY: McGraw Hill, 661-665.

ANA Scope & Standards Model (2001)

Human Intellect

Data

Information

Knowledge

Fig. 1 Transformation of Data to Knowledge

Source: ANA. (2001, proposed). The Scope of Practice of Nursing Informatics and the Standards of Practice and Professional Performance for the Informatics Nurse Specialist

Informatics Competencies

Levels of Competency Beginning Nurse Experienced Nurse Informatics Nurse Specialist Informatics Innovator

Types Computer Skills Informatics Knowledge Informatics Skills

Informatics Competencies: Three Areas

Computer Literacy a set of skills that allow individuals to use computer

technology to accomplish tasks.

Informatics Knowledge a set of cognitive processes that allows the individual

to recognize what, when, and where information is needed and to locate, evaluate, and use that information appropriately.

Informatics Skills the technical ability to use tools and techniques to

improve information and knowledge access, integration, management and use.

Beginning Nurse: Informatics Competencies

Has basic computer skillsUses applicationsUses sources of dataUses technology for care delivery, communication, and decision supportRespects and protects patients’ rights to privacy and confidentiality of information

Experienced Nurse:Informatics Competencies

Understands the value of data and informationUses technology to trend and aggregate individual and population-based patient information for decision support and communication Evaluates quality of information sourcesAdvocates for technology solutions that improve care delivery

Informatics Nurse Specialist: Informatics Competencies

Uses advanced systems and tools to manage, evaluate, integrate, and communicate data, information and knowledgeAssesses current capabilities and limitations of technology and their impact on users and organizationsManages IT projects across the systems life cycleActively seeks to improve the information and knowledge available for clinical decision-making

Informatics Innovator: Informatics Competencies

Conducts research related to nursing informaticsInfluences top-level decisions and policy design which impact clinical information management Builds theoretical models of NIEvaluates system level informatics initiatives

Roles of the Informatics Nurse Specialist

Project ManagementConsultationEducationResearchSystem DevelopmentDecision Support/Outcomes ManagementPolicy Development Entrepreneur

Information Needs and Tools for Practice

Sound Clinical Decision MakingEvidence Based PracticeStandardized VocabulariesClinical Information Systems

Electronic Patient Records: Development Constraints

Need for standards in clinical terminologyConcerns about data privacy, confidentiality and securityData entry challengesIntegration of records and other information resources

Research PrioritiesBrennan, Zielstorff, Ozbolt, & Strombom, 1998)

Standardized language/vocabulariesTechnology development to support practice/ patient careData base issuesPatient use of information technologiesUsing telecommunications technology for nursing practicePutting technology into practiceSystems evaluation issuesInformation needs of nurses and other cliniciansNursing intervention innovations for professional practiceProfessional practice issues

Assumptions to be Challenged

Organization of electronic systems Desktop metaphor EMR

Chronological structure Set of processes to be supported by

technology