MODULE 4  Second Generation- include an abstract terminology

LESSON A: INFORMATICS THEORY model or terminology model schema that describes

the organization of the main categories used in a
ADVANCED TERMINOLOGY SYTEM particular terminology or set of terminologies.(e.g
ICNP)
The Vocabulary Problem
1. The development of multiple terminologies has resulted in  Third Generation- grammar that defines the rules for
overlapping content, areas for which no content exist, and automated generation and classification of new
large number of codes and terms. concepts.

2. It is often developed to provide sets of terms and definitions ADVANTAGES OF ADVANCED OF TERMINOLGY SYSTEM
of concepts for human interpretations with computer Two Important Facts of Knowledge Representation for
interpretation as only secondary goal. computer-based system that support clinical care:
1. Describing concepts
2. Manipulating and reasoning about those concepts
3. Knowledge that is eminently understandable to human is
using computer-based tool.
often confusing, ambiguous or opaque to computers and
consequently, current efforts have often consulted in
terminologies that are inadequate in meeting the data needs of ADVANTAGES from First Facet:
todays healthcare system. 1. Nonambiguous- representation of concepts
2. Facilitation of Data Abstraction without loss of original data.
3. Nonambiguous mapping among terminologies.
CONCEPT ORIENTATION
4. Data reuse in different contexts.
Concept oriented approaches-understanding
definitions of and relationships among things in the
ADVANTAGES FROM 2ND FACET include:
world(objects), our thoughts about things in the
1. Automated classification of new concepts and an ability to
world(concepts) and the labels we use to represent and
support multiple inheritance of defining characteristics. (e.g
communicate our thoughts about things in the world (terms)
“acute postoperative pain”)

 Concept- (i.e. thought or reference): unit of ADVANCED TERMINOLOGICAL APPROACHES IN

knowledge created by a unique combination of NURSING
characteristics- an abstraction of a property of an ISO 18104:2003- an international standards covering reference
object or set of objects. terminology models for nursing diagnoses.
– this was developed to harmonize the plethora of
 Object- (i.e. referent)- anything perceivable or nursing terminologies in use around. the world.
conceivable. – the terms and definitions taken from ISO Health
Term- (i.e. symbol)-verbal designation of a general Informatics- integration of reference terminology of
concept in a specific subject field- a general concepts nursing . www.iso.org
corresponds to two or more
Uses of Terminology Model
COMPONENTS OF ADVANCED TERMINOLOGY SYSTEM 1. Facilitate the representation of nursing diagnosis and
Terminology Model- concept- based representation of a nursing action concepts and their relationships in a manner
collection of domain specific terms that is optimized for the suitable for computer processing.
management of terminological definitions. 2. Provide a framework for the generation of compositional
 Schemata – reflect plausible combinations of expressions from atomic concepts within a reference
concepts e.g “dyspnea” may be combined with terminology.
“severe” to make “severe dyspnea” 3. Facilitate the mapping among nursing diagnosis and nursing
 B. Type Definitions- are obligatory conditions that actions among various terminologies.
state only the essential properties of a concept. e.g. a 4. Enable the systematic evaluation of terminologies and
nursing must have a recipient, an action and a target. associated terminology models for purposes of harmonization.
5. Provide a language to describe the structure of nursing
ADVANCE TERMINOLOGY SYSTEM diagnosis and nursing action concepts in order to enable
Representation Language appropriate integration with information models.
Ex. GALEN, GRAIL, KRSS,OWL
 Ontology languages –represents classes( referred to
as concepts, categories or types) and their properties GALEN- concept oriented approach program. Supports the
(also referred to as relations, slots, roles, or authoring, maintenace, and quality assurance of other kinds of
attributes ) terminologies.
 Computer-Based Tools- representation language
maybe implemented using description logic within a GRAIL – an ontology language for representing concepts and
software system or by a suite of software tools. their interrelatinships.

ADVANCED TERMINOLOGY Tools used in GRAIL

 First Generation Terminology- system consist of a 1. A computer-based modelling environment-
list of enumerated terms, possibly arranged as a facilitated the collaborative formulation of models and
single hierarchy.(e.g NANDA) allows authoring of clinical knowledge at different level
of abstraction.
 2. Terminology Server- a software system that
implements GRAIL. Its functions include.
a. internally managing and representing the
model.
b. resting the validity combination of concepts.
c. Constructing valid composed concepts.
d. Transforming composed concepts into
canonical form
e. Automatically classifying composed concepts
into the
hierarchy.

3. SNOMED RT- is a reference terminology optimized

for clinical data retrieval and analysis.

Functionality:
1. Acronym resolution, word completion, term completion,
spelling correction, display of t form of the authoritative form of
the term entered by the user and decomposition.
2. Automated classification
3. Conflict management, detection and resolution

An illustration of a potential mapping using an advanced

terminology system between nursing activity concepts
from two existing terminology system.
NURSING INFORMATICS and information to support nursing practice,
INFORMATICS THEORY administration, education, research, and the
expansion of nursing knowledge.(modified definition
MODELS FOR NURSING INFORMATICS by ANA from Graves and Corcoran )
 Models- are representations of some aspect of the
real world.  Scope and Standards of Nursing Informatics
 Theories, Models, Framework- guide nursing Practice includes the expanded definition of
informatics learning activities for both students and Nursing Informatics.
faculty. – is a specialty that integrates nursing science,
computer science, and information science
FOUNDATIONAL DOCUMENTS GUIDE NI PRACTICE to manage and communicate data,
 Code of Ethics for Nurses with Interpretive information and knowledge in nursing
practice. NI facilitates the integration of data,
Statements- a complete revision of previous ethics
provisions and interpretive statements that guide all information and knowledge to support
patients, nurses, and other providers in
nurses in practice, be it in in the domain of patient
care, education, administration or research. decision making in all roles and settings
( Published by ANA)
MODELS FOR NURSING INFORMATICS
 Nursing Social Policy Statement provided a new  Graves and Corcoran’s model placed data,
definition of Nursing. information, and knowledge in sequential boxes with
one way arrows pointing from data, to information to
 Nursing is the protection, promotion and optimization knowledge. The management processing to each of
of health and abilities, prevention of illness and injury, the three boxes. This model is direct depiction of their
alleviation of suffering through the diagnosis and definition of knowledge.
treatment of human response and advocacy in the
care of individuals, families, communities and
populations. (ANA, 2003)

 Nursing: Scope and Standards Practice -further

reinforces the recognition of Nursing as a cognitive
profession
– the measurement criteria are associated with
each 15 standards and include data
information and knowledge management
activities as core work for all nurses.
– the cognitive work begins with critical
thinking and decision-making components of
the nursing process that occur before
nursing actions begins.

MODELS
INFORMATICS AND HEALTHCARE INFORMATICS (1986)- Patrcia Schwirian -proposed a model of nursing
DEFINITIONS informatics intended to stimulate and guide systematic
 Informatics- is a science that combines a domain research in the discipline.
science, computer science, information science, and – The model provides a framework for
cognitive science. identifying significant information needs,
 Healthcare Informatics-integration of healthcare which in turn can foster research.
sciences, computer science, information science ad – There are four elements arranged in a
cognitive science to assist in the management of pyramid with a triangular base.
healthcare information.
PATRICIA SCHWIRIAN MODEL
HEALTHCARE INFORMATICS AND SUBDOMAINS OF
HEALTHCARE INFORMATICS
 Medical Informatics
 Pharmacy Informatics
 Dental Informatics
 Nursing Informatics

NURSING INFORMATICS
Nursing Informatics- is the use of information technologies in
relation in to any nursing functions and actions of nurses
(definition as proposed by Kathryn Hannah
 is the specialty that integrates nursing science,
computer science and information science in Turley Model
identifying, collecting, processing, and managing data – (1996)- Turley model core components of informatics
 – (cognitive science,, information science, and
computer science) are depicted as intersecting circle.
Nursing science has a larger circle completely ELECTRONIC HEALTH RECORD
encompasses the intersecting circles. EHR – any information related to the past, present or future
physical/mental health or condition of an individual. (ASTM)
 the information resides in electronic system used to
TURLEY MODEL capture, transmit, receive, store, retrieve, link and
manipulate data for the primary purpose of providing
healthcare and health related services.
 NCVHS- identified patient medical information
necessary for HER

1. Personal Health dimension – includes personal health

record of individual, family,directories of healthcarre and public
health service providers

2. Healthcare provider Dimension- promotes quality patient

care, access to complete data 24 hrs for 7 days/wk, decision
support programs, and practice guidelines.

DATA, INFORMATION,KNOWLEDGE 3. Population Health Dimension- information on the health

Data, Information, and knowledge are overarching concepts for population and influences on that health.
Nursing informatics.
 Data- discrete entities that described objectively
without interpretation. TERMINOLOGIES
 Information- reflects interpretation, organization or  NANDA (E-mail:info@nanda.org)- classification of
structuring data. It is the result of the processing data. nursing diagnosis in a taxonomy. ( has 167
 Data Processing- it occurs when raw facts are recognized nursing diagnosis)
transformed through the application of context to give
those facts meaning.  Nursing Interventions Classifications (NIC)-
describe the treatments nurses perform,updated
COMPETENCIES linkages with NANDA diagnosis and core
 Knowledge- is information that is synthesized so that interventions identified.
relationships are identified and formalized
 ANCC- developed and maintains the nursing  Nursing Outcome Classification(NOC) –researched
informatics certification examination. based outcome to provide standardization of expected
patient, caregiver,family,and community outcomes for
measuring the effect of nursing intervention,
Test Content
1. Human Factors System Life Cycle ( system planning,
 Clinical Care Classification(CCC)- researched
analysis, design, implementation and testing, evaluation,
based nomenclature designed to standardized the
maintenance and support)
terminologies for documenting nursing care. In all
clinical care settings.
2. Information Technology ( hardware, software,,
communication, data representation, and security)  Omaha System- It includes an assessment
component , intervention component and outcome
3.Information Management and Knowledge generation (Data, component.(Problem Classification Scheme,
Information, Knowledge) Intervention Scheme, and Problem Rating Scale for
outcome)
4.Professional Practice, trends and Issues ( roles, trends,
issues and ethics)  SNOMED CT- is a core clinical terminology
containing over 357,000 healthcare concepts with
5. Models and Theories (foundation of Nursing Informatics,, unique meaning and formal logic based definition.
nursing and healtcare data sets, classification system and
nomenclatures, related theories and sciences)  ABC codes- provide a mechanism for coding
integrative health interventions by clinicians by state
HEALTHCARE INFORMATIN AND MANAGEMENT SYSTEM location for administrative billing and insurance
SOCIETY ( HIMSS) claims.
– recently established a certification program that
maybe of interest ot nursing informatics.  Patient Care Data Set- (PCDS)-includes terms and
codes for patient problems, therapeutic goals and
patient care orders.
CERTIFICATIONS AVAILABLE INCLUDES
1. CPHIMS (Certifies Professional in Healthcare Informatin &
Management system  Logical Observation Identifiers Names and Codes(
2. CHS- Certified in Healthcare Security (LOINC)- 32,000 terms. Includes codes for
3. CHP- Certification in Healthcare Privacy observations at key stages for nu rsing process,
4. CHPS-Certified in Healthcare Privacy and Security assessment, goals and outcome. Results for
hematology,s erology, microbiology and toxicology.
  International Classification for nursing Practice
( ICNP)- includes nursing phenomena,(nsg
diagnosis), nursing actions, and nursing outcome.

 Nursing Management Minimum Data set (NMMDS)

-terms to describe the context and environment of
nursing practice, nursing delivery, care delivery
method, personnel characteristics and financial
resources.

ORGANIZATION AS RESOURCES
Membership and active participation in professional
organization demonstrate compliance in the provision 8 & (9 of
Code of Ethics for Nurses
1. American Medical Association- dedicated for the
development and application of medical informatics in the
support of patient care, teaching, research, and healthcare
administration.

2. Healthcare Information and Management system

Society-its members are responsible in the developing many
of todays innovations in healthcare delivery and administration,
including telehealth, CPR, EHR,c ommunity information
networks and wireless healthcare computing.

3. National League for Nursing- its mission is to advance

quality nursing education that prepares the nursing workforce
to meet the needs of diverse population in an ever changing
healthcare environment.

4. Society for Health System- enhance the career

development and continuing education of professionals who us
industrial and management engineering expertise for
productivity and quality in healthcare industry.

5. Association for Computing Machinery- major force in

advancing the skills for information technology professionals
and students worldwide.

6. ARMA- provide education, research, and networking

opportunities to information professionals to enable them use
their skills to leverage the value of od records , information and
knowledge to organizational success.

7.American Society for Information Science- as the society

for information professionals leading the search for new and
better theories, techniques and technologies to improve access
to information.
IMPLEMENTING AND UPGRADING CLINICAL 1. To thoroughly understand the department’s
INFORMATION SYSTEM information needs.
2. To gain a full understanding of the software features
CLINICAL INFORMATION SYSTEM and functions.
CIS – assist clinicians with the data necessary for decision 3. To merge the new system’s capabilities with the
making and problem solving. department’s operations
4. To assist in the system testing effort.
MAJOR CIS REQUIREMENT FOR NURSING 5. Participate in developing and conducting end-user
1. Administer a nursing department education.
2. Assist the management of nursing practice. 6. Provide high level support during initial activation.
3.Assist nursing education
4.Support nursing research
THE PLANNING STEPS INVOLVES:
CLINICAL INFORMATION SYSTEM COMMITTEE 1. Definition of the Problem
STRUCTURE AND PROJECT STAFF 2. Feasibility study
 The Nursing administrator in conjunction with the 3. Documentation and negotiation of project scope
information system management team works to agreement.
develop a committee structure and participation to 4. Allocation of resources
best guarantee success of the project.

 Transition Management- is a series of “...deliberate A. Definition of the Problem

planned intervention undertaken to assure successful – essential to it is the precise statement of the goal and
adaptation/assimilation of a desired outcome into outcome
organization.” (Douglas and Wright) Ex. Unfair nurse staff assignments may relate to
invalid patient classification tool (inaccurate grouping
CLINICAL INFORMATION SYSTEM STEERING of patients)
COMMITTEE
The CIS steering committee generally includes representatives B. Feasibility study
from the following areas. – helps identify the information needs, objectives and
1. Hospital administration/hospital finance scope of the project. Helps analyzing multiple
2. Nursing Administration parameters and by presenting possible solutions
3. Medical Staff whether the proposed system outweigh the cost.
4. Information system departments at manager/director It seeks to answer…..
level Ex. What’s the real problem to be solved or goal to
5. Major ancillary departments (lab, radiology, meet?
pharmacy, dietary, records, accounting) What are the estimated cost?
6. Health Information management (medical records) What are the known limitations and risk to the
7. Legal affairs project?
8. Outside consultants (as needed)
9. Other appointed members Planning Phase- Feasibility Study
1. Statement of the Objectives- outcome oriented and
The Steering committee is charged with providing oversight stated in measurable terms.
guidance to the selection and integration of a new CIS into the 2. Environmental Assessment- project is evaluated
organization. relative to organizations competitions. The impact of
legal, regulatory and ethical considerations is
PLANNING PHASE reviewed.
Project Team- it is led by an appointed project manager and 3. Determination of information needs- needs
includes a designated team leader for each of the major assessment and outlines the high level information
departments affected by the system selection, implementation, required by the users.
or upgrade proposed. 4. Determination of Scope-the scope of the proposed
system.
The Objectives of the project team are: 5. Development of Project Timeline- the project
1. Understand the technology and technology workplan, the steps required for each phase are
restrictions if any of a proposed system. outlined in sufficient detail.
2. Understand the impact of intradepartmental decisions. 6. Recommendations- based on the finding of the
3. Make decisions at the intradepartmental level for the feasibility study.
overall good of the CIS within the organization.
4. Become the key resource for their application. C. Documentation and Negotiation of a Project Scope
Agreement
THE PLANNING STEPS – The project scope agreement is drafted by the project
Project Manager- is responsible in managing all aspect of the team and submitted to theprojects steering
project. It includes software application development, committee.
hardware, and networks as well as oversight management of
the interfacing and conversion task. D. Allocation of Resources
– It considers the following when planning for reources:
Departmental Teams 1. Present staff workload
2. Human resources
3. Cost of operation
4. Relationship of implementation events with non-project Functional Design Document – is the overview statement of
events ( ex. JCAHO reviews) how the new system will work. It outlines the human and
5.Anticipated training cost. machine procedures, the input points, the processing
6. Space availability requirement, output from the data entry and major reports
7. Current and anticipated equipment requirements for the generated from the system.
project team.
Functional design- is a concise description of the functions
THE KEY ROLE OF THE NURSE ADMINISTRATOR required from the proposed computerized system and
Nurse executive involvement plays a critical role in the describes how the application performs its task. Then database
success of CIS implementation or upgrade. Business plan structure will be determined.
features the following..
1. An executive summary 2. DATA ANALYSIS-
2. An introduction – provides data for development of an overview of the
3. An environmental assessment of the CIS iin use by nursing problem and or stated goal defined in the
similar hospital. project scope agreement.
4. An analysis of nsg depatment culture, policies and
information needs.
5. An overview of the design and implementation plan 3. DATA REVIEW-
describing the objectives, strategy, equipment needs, – The third step in the analysis phase is to review the
staffing projections etc. data collected in the feasibility study, the workflow
6. Financial plan projecting staffing, budget, expenses, documents, and the functional specification and
capital expenditures and miscellaneoous provide recommendations to the project steering
expenditures. committee for the new system.

– The review focuses on resolving the problems and

SYSTEM ANALYSIS PHASE attaining the goals defined in the feasibility study
– it is the second phase of developing a CIS – is a “fact based on the best methods or pathways derived from
finding phase” the workflow documents and the functional design.

– All data requirements related to the problem defined 4. SYSTEM PROPOSAL DEVELOPMENT-
in the project scope agreement are collected and – the final step in the system analysis stage is to
analyzed to gain a sound understanding of the current create a system proposal document.
system, how it is used and what is needed in the new
system. – It sets forth the problems and/or goals and the
requirements for the new system’s overall design.
5 STEPS
1. Data collection – It outlines the standards, documentation, and
2. Data Analysis procedures for management control of the project,
3. Data Review and it defines the information required, the necessary
4. Benefits identification resources, anticipated benefits, a detailed workplan,
5. System Proposal Development and projected costs for the new system.

The system proposal document answers four questions:

1. DATA COLLECTION 1. What are the major problems and goals under
– collecting of data reflecting the existing problem or consideration?
goal as the first step in system analysis phase. 2. How will the proposed CIS solution correct or eliminate the
– as a result of data collection two documents were problems and/or accomplish the stated goals?
created. 3. What are the anticipated costs?
4. How long will it take?
1.1 Workflow Document-data collected into logical
sequencing of task and subtask performed by end user.  The system proposal describes the project in sufficient
includes the following; detail to provide a management level understanding of the
1.1.1 List of assumptions about the process or work system or application without miring in minutiae.
effort.  The format of the final system proposal includes the
1.1.2 A list of the major task performed by the user. following information:
1.1.3 A list of subtask and steps the user accomplishes 1. A concise statement of the problems and/0r goals
and outlines. 2. Background information related to the problem
3. Environmental factors related to the problem
a. Competition
Multiple Sources of Data for completing a workflow
b. Economics
document.
e. Politics
1. Written documents, forms, and flow sheets
d. Ethics
2. Policy and procedure manuals
4. Anticipated benefits
3. Questionnaires
5. Proposed solutions
4. Interviews
6. Budgetary and resource requirements
5. Observations
7. Project timetable

THE SYSTEM DESIGN PHASE

 – The design detail of the system and the detailed testing the conversion programs
plans for implementing the system are developed for
both the functional and the technical components of 4. IMPLEMENTATION PLANNING
the system.  last step in system design to establish detailed
implementation workplan.
 workplan identifies a responsible party, and a
beginning date and end date for each phase, step,
Three major steps in the system design phase: task and subtask.
1. Functional specifications
 this plan coordinates all task necessary to complete
2. Technical specifications
the development of new software, implement a new
3. Implementation planning
system and upgrade a current system.

1. Functional specifications
 Use the functional design document developed in the THE TESTING PHASE
system analysis phase of a CIS and builds on the
 the new system or commercially available must be
design by formulating a detailed description of all
tested to ensure that all data are processed correctly
system inputs, outputs, and processing logic required
and the desired outputs are generated. To ensure if
to complete the scope of the project.
programs are written correctly, the ff are done.
 It further refines what the proposed system will
o Unit testing- conducted by individual
encompass and provides the framework for its
programmers
operation.
o Alpha testing-done by system assurance
 Commercial software vendors provide manuals,
group within the development organization
usually application-specific, include an introduction, a
o Beta testing- occurs at the first client site
section for each pathway, and technical section.
 The hospital’s departmental and project teams
produce the organization’s functional specification by When commercially available software, the ff are
evaluating the available commercial software’s recommended.
functions with the workflow documents and making 1. Functional test-departmental teams test and verify
decisions on the pathways and functions to be used databases.
by the institution. 2. Integrated system test- total system is tested; this includes
interfaces between systems as well as interplay between
applications within the same system.
2. Data Manipulation and Output
3. Final testing- is within the end user training
 The design team creating the new application often
works closely with the programmers, making
adjustments in the design and specification based on
new perspectives, programming logic, and DOCUMENT SYSTEM
technologies.  documentation begins with the final system proposal
 several manuals are prepared like user’s manual, a
3. Technical Specification reference manual, and operator’s maintenance
manual.
 Technical manager works on the four major areas
1. Hardware: the ability to operate the new application on
multiple hardware platforms is often desired.
TRAINING PHASE
Ex. terminals., handheld devices, printers, upgrade a network,
building computer rooms  training takes place before and during the activation of
the new system.
 two training takes place; project team and selected
2. Application Software: establishing technical specifications members of the departmental team and the end user
outlining the operational requirements for the new system. training
- specifications detail the procedures required to maintain the
application software IMPLEMENTATION PHASE
 describes series of events required to begin using the
3. Interface System: defines those programs and processes system or application in the production or live
required to transmit data between two disparate system. environment and details the necessary computer and
software maintenance operations required to keep the
system running.

Activation approaches
• Parallel
• Pilot
•Phased-in
•Big bang theory

EVALUATION PHASE
 describes and assesses, in detail the new system
4. Conversions: conversion of data from legacy system to the performance identifying the strenght and weaknesses
new system of the implementation process.
- determining the conversion requirements and developing and
 determine whether it has accomplished the stated
goal
 if it continuously meet the need of the users.