INFORMATICS

THEORY 

THEORIES, MODELS AND FRAMEWORK

  Nursing Informatics models is composed of 5 general models. 1st, Graves and Corcoran's model. 2nd, Schiwirian's model. 3rd, Turley's model. 4th,

Data Information Knowledge (D-I-K) model. And the last is Benner's Novice to Expert model. The 2

specific informatics models are Philippine Health Ecosystem model and Shift Left model. 

According to GRAVES AND CORCORAN’S MODEL (1989) that nursing informatics as the linear progression, from data into information

and knowledge. Management processing is integrated within each elements, depicting

nursing informatics as the proper management of knowledge, from data as it is converted into

information and knowledge.

According to SCHIWIRIAN’S MODEL (1986), nursing informatics involves identification of information needs, resolution of the needs, and attainment of nursing goals/objectives. Patricia Schwirian proposed a model intended to stimulate and guide systematic research in nursing informatics, model/framework that enables identification of significant information needs, that can foster research (somewhat similar to Maslow’s hierarchy of needs).

According to TURLEY’S MODEL (1996), nursing

informatics is the intersection between the discipline-

specific science (nursing) and the area of informatics. And

in this model, there are 3 core components of informatics, namely Cognitive science, Information science, and

Computer science.

Novice 

Advanced Beginner 

Competent 

Proficient

 Expert

BENNER’S LEVEL OF

EXPERTISE MODEL

Personal Health Dimension - personal health record maintained and controlled by the individual or family; nonclinical information.

Health Care Provider Dimension - promotes quality patient care, access to complete accurate patient data 24/7.

Population Health Dimension – information on the health of the population and the influences to health; helps stakeholders identify and track health threats, assess population health, create and monitor programs and services, and conduct research.

PATIENT MEDICAL RECORD INFORMATION MODEL (PMRI):

ABC CODES:

- mechanism for coding integrative health interventions by clinician for administrative billing and insurance

claims.

- includes complementary and alternative medicine interventions and codes that map

all NIC, CCC, and Omaha system interventions.

Perioperative Nursing Data Set (PNDS):

universal language for perioperative nursing practice and education; standerdize documentation of

perioperative data in all perioperative settings.

diagnosis based on NANDA, interventions based on NIC, and

outcomes based on NOC.

SNOMED CT:core clinical

terminology containing over 357,000 healthcare concepts with unique meanings and formal

logic-based definitions organized into multiple

hierarchies.

Advanced Terminology Systems

The primary motivation for standardized terms in nursing is the need for valid, comparable data that

can be used across information system applications to support

clinical decision-making and the evaluation of processes and

outcomes of care.

The Vocabulary Problem

Reasons for the vocabulary problem in health and nursing informatics:• The development of multiple

specialized terminologies has resulted in areas of overlapping content, areas for which no content exists, and large numbers of codes and terms.

• Existing terminologies are most often developed to provide sets of terms and definitions of concepts for human interpretation, which computer interpretation as only a secondary goal.

The failure to achieve a single, integrated terminology with broad coverage of the

healthcare domain.

The Semiotic Triangle

Object

Concept Term

Components of Advanced Terminology Systems

Terminology Model

Representation Language

Computer-Based Tools

Advantages of Advanced Terminology Systems

Allow much greater granularity through

controlled composition while avoiding a

combinatorial explosion of pre-coordinated terms

Facilitate two important facets of knowledge representation for computer-based systems that support clinical care:

(a) describing concepts, and (b) manipulating and reasoning about those

concepts using computer-based tools

Motivated in part by a desire to harmonize the plethora of nursing terminologies around

the world and to integrate with other evolving

terminology and information and model standards.

Advanced Terminological Approaches to Nursing

GALEN ProgramCan be used in a range of ways, from directly

supporting clinical applications to supporting the authoring, maintenance and quality assurance

of other kinds of terminologies.

SNOMED RT

• SNOMED Reference Terminology (TR) is a reference terminology optimized for clinical data retrieval and analysis

• Concepts and relationships in SNOMED are represented using modified KRSS (Knowledge Representation Specification Syntax) rather than GRAIL

• Concept definition and manipulation are supported through a set of tools with functionality such as Acronym resolution, word completion, term completion, spelling correction, display of the authoritative form of the term entered by the user, and decomposition of unrecognized input

Implementing and

Upgrading Clinical

Information Systems

- Provide nurses knowledge of many aspects organized for effective and efficient

healthcare delivery. 

- Assists clinicians with data necessary for decision-

making and problem solving

- Must serve the organization and the patient in much the same way an

efficient healthcare delivery system involves all appropriate departments in

establishing healthcare delivery processes

The Planning Phase

Begins once an organization has

determined that an existing need or problem may be

filled or solved by the development of a CIS

The Clinical Information System (CIS)

Clinical Information System Committee Structure and Project

Staff

- The nursing administrator, in conjunction with the information

system’s management team, works to develop a committee structure and participation to best guarantee the success of

the projectTransition management is a series of deliberate, planned interventions undertaken to

assure successful adaptation/ assimilation of a desired

outcome into an organization. (Douglas and Wright, 2003)

Project TeamLed by an appointed project manager and

includes a designated team leader for each of the major departments affected by the system

selection, implementation, or upgrade proposed

Objectives:- Understand the technology and its

restrictions, if any, of a proposed system

- Understand the impact of intradepartmental decisions

- Make decisions at the intradepartmental level for the overall

good of the CIS within the organization

- Become the key resource for their application

The Key Role of the Nurse Administrator

The active involvement of the nurse executive is considered a critical success factor of any CIS implementation or

upgrade.

The System Analysis Phase- Second phase of developing a CIS

- Is the fact finding phase- Foundational to the actual system design

Data Collection- Collection of data reflecting the existing problem or goal.

- Refining of the project scope agreement- Creation of a Workflow Document

VV

1. data collected into logical sequencing of tasks and subtasks performed by the end users for each goal or problem area, it includes:- A list of assumptions about the process- A list of major tasks performed- A list of subtasks and steps accomplished

2. Sources:- Written documents, forms, and flow sheets- Policy and procedure manuals- Questionnaires- Interviews- Observations

Data Analysis

- Provides the data for development of an overview of the nursing problem and or stated goal defined in the project scope agreement- Tools used:Data flowchartGrid chartDecision tableOrganizational chartModel

V

V

Data Review

Focuses on resolving the problem and or attaining the goals defined in the feasibility study based on the best

method or pathways derived from the workflow documents and the

functional design.

Benefits Identification

The overall anticipated benefits from the system are documented

in this step.The benefits reflect the resolution

of the identified problem, formulated and stated in

quantifiable terms

V