Health Informatics (formerly Computers in Health Care)

Health Informatics

(formerly Computers in Health Care) Kathryn J. Hannah Marion J. Ball

Series Editors

Health Informatics Series

(formerly Computers in Health Care)

Series Editors

Kathryn J. Hannah Marion J. Ball Dental Informatics

Integrating Technology into the Dental Environment L.M. Abbey and J. Zimmerman

Ethics and Information Technology

A Case-Based Approach to a Health Care System in Transition J.G. Anderson and K.W. Goodman

Aspects of the Computer-Based Patient Record M.J. Ball and M.F. Collen

Performance Improvement Through Information Management Health Care’s Bridge to Success

M.J. Ball and J.V. Douglas

Strategies and Technologies for Healthcare Information Theory into Practice

M.J. Ball, J.V. Douglas, and D.E. Garets Nursing Informatics

Where Caring and Technology Meet, Third Edition M.J. Ball, K.J. Hannah, S.K. Newbold, and J.V. Douglas Healthcare Information Management Systems A Practical Guide, Second Edition

M.J. Ball, D.W. Simborg, J.W. Albright, and J.V. Douglas Clinical Decision Support Systems

Theory and Practice E.S. Berner

Strategy and Architecture of Health Care Information Systems M.K. Bourke

Information Networks for Community Health P.F. Brennan, S.J. Schneider, and E. Tornquist Informatics for the Clinical Laboratory A Practical Guide

D.F. Cowan

Introduction to Clinical Informatics P. Degoulet and M. Fieschi Behavioral Healthcare Informatics

N.A. Dewan, N.M. Lorenzi, R.T. Riley, and S.R. Bhattacharya

(continued after Index)

Kathryn J. Hannah Marion J. Ball Margaret J.A. Edwards

Introduction to Nursing Informatics

Third Edition

With 45 Figures

Kathryn J. Hannah, PhD, RN Marion J. Ball, EdD President, Hannah Educational Vice President, Clinical

& Consulting Services, Inc. Informatics Strategies Calgary, Alberta, T3B 4ZB Healthlink, an IBM company

Canada Baltimore, Maryland 21210

and USA

Professor, Department of and

Community Health Sciences Professor, Johns Hopkins University

Faculty of Medicine School of Nursing

University of Calgary Baltimore, Maryland, 21205

Calgary, Alberta T2N 4N1 USA

Canada

Margaret J.A. Edwards, PhD, RN Professor and Coordinator,

Graduate Programs

Centre for Nursing and Health Studies Athabasca University

Athabasca, Alberta T9S 3A3 Canada

and

President, Margaret J.A. Edwards

& Associates, Inc.

Calgary, Alberta T2W 2A6 Canada

Library of Congress Control Number: 2005929460 ISBN -10: 0-387-26096-X

ISBN -13: 978-0387-26096-9 Printed on acid-free paper.

C

2006 Springer Science +Business Media, Inc.

All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science +Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.

The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.

Printed in the United States of America. (TB/SBA) 9 8 7 6 5 4 3 2 1

springeronline.com

The three authors of this book share many experiences, interests, and

values. The strongest of these shared values is a firm belief in marriage

and family. We dedicate this book to our husbands, Richard Hannah,

John Ball, and Craig Edwards, who are our respective life partners,

our friends, and our greatest individual sources of support. We also

dedicate this book to our families, especially the youngest generation,

which represents the future: Richard Steven Hannah, Cameron Robert

Hannah, Kyle James Hannah, Alexis Marion Concordia, Michael John

Concordia, Erica Adelaide Concordia, Alexander John Ball, Ryan Jokl

Ball, Maryn Joy Edwards, and John Kurt Edwards.

Series Preface

This series is directed to healthcare professionals who are leading the trans- formation of healthcare by using information and knowledge. Launched in 1998 as Computers in Health Care, the series offers a broad range of ti- tles: some addressed to specific professions such as nursing, medicine, and health administration; others to special areas of practice such as trauma and radiology. Still other books in the series focus on interdisciplinary issues, such as the computer-based patient record, electronic health records, and networked healthcare systems.

Renamed Health Informatics in 1998 to reflect the rapid evolution in the discipline now known as health informatics, the series will continue to add titles that contribute to the evolution of the field. In the series, eminent experts, as editors or authors, offer their accounts of innovations in health informatics. Increasingly, these accounts go beyond hardware and software to address the role of information in influencing the transformation of health- care delivery systems around the world. The series also will increasingly focus on “peopleware” and the organizational, behavioral, and societal changes that accompany the diffusion of information technology in health services environments.

These changes will shape health services in the new millennium. By mak- ing full and creative use of the technology to tame data and to transform information, health informatics will foster the development of the knowl- edge age in health care. As coeditors, we pledge to support our professional colleagues and the series readers as they share advances in the emerging and exciting field of Health Informatics.

Kathryn J. Hannah Marion J. Ball

vii

Preface

The first book in the Computers in Health Care series, Introduction to Nurs- ing Informatics, was published more than a decade ago. The third edition of this book is intended to be a primer for those just beginning to study nursing informatics, providing a thorough introduction to basic terms and concepts.

We have listened to feedback about the two earlier editions from readers.

The book has been reorganized and restructured. New material has been added and new information incorporated. The book introduces terms and concepts foundational to nursing informatics and provides an introduction to the Internet. An overview of nursing use of information systems is pro- vided. The book includes an exploration of the most common applications of nursing informatics in clinical nursing practice (both community and facility settings), nursing education, nursing administration, and nursing research.

It also provides insight into practical aspects of the infrastructure elements of the informatics environment. An overview of professional nursing infor- matics education and the future for nurses in health informatics concludes the book.

Although readers will no doubt find diverse uses for this book, we have written it with three principal uses in mind:

University and College Baccalaureate Nursing Programs and Health Infor- mation Science Programs: to acquaint undergraduate students in nursing and health information science with the field of nursing informatics. This book provides students with a fundamental understanding of the field of nursing informatics necessary for them to be able to use computers and information management strategies in their practices, to make informed choices related to software/hardware selection and implementation strategies, and to use the more advanced volumes in the Springer series.

Nursing Administrators: to familiarize themselves with the field of nurs- ing informatics in preparation for implementing computerized solutions for information management in their institutions. Practical guidelines will assist the manager in making informed decisions regarding system selec- tion/development, implementation, and use.

ix

x Preface

Reference: to involve nursing unit managers and staff in the implemen- tation of computer applications and automated information management strategies in their workplaces. This book would be used to familiarize staff with the field of nursing informatics. In addition, the practical information facilitates implementation and use of computer applications.

We believe that this book, Introduction to Nursing Informatics, Third Ed- dition, and the companion volume, Nursing Informatics: Where Caring and Technology Meet, provide comprehensive coverage of nursing informatics.

We hope that through this book we can introduce newcomers to the ex- citement of nursing informatics and share our enthusiasm for this rapidly evolving field.

Calgary, Alberta, Canada Kathryn J. Hannah

Baltimore, Maryland, USA Marion J. Ball

Calgary, Alberta, Canada Margaret J.A. Edwards

Contents

Series Preface v Preface vii Contributors xiii

PART I FOUNDATIONS OF NURSING INFORMATICS

Chapter 1 Nurses and Informatics 3

Chapter 2 Anatomy and Physiology of Computers 12 Chapter 3 History of Healthcare Computing 27 Chapter 4 Telecommunications and Informatics 41

PART II NURSING USE OF INFORMATION SYSTEMS

Chapter 5 Enterprise Health Information Systems 57

Chapter 6 Nursing Aspects of Health Information Systems 84

PART III APPLICATIONS OF NURSING INFORMATICS

Chapter 7 Clinical Practice Applications: Facility Based 105 Chapter 8 Clinical Practice Applications: Community Based 118 Chapter 9 Administration Applications 129

Chapter 10 Education Applications 142 Chapter 11 Research Applications 155

xi

xii Contents

PART IV INFRASTRUCTURE ELEMENTS OF THE INFORMATICS ENVIRONMENT

Chapter 12 Nursing Data Standards 171

Chapter 13 Defining Information Management Requirements 189 Chapter 14 Selection of Software and Hardware 199

Chapter 15 Data Protection 218 Chapter 16 Ergonomics 234

Chapter 17 Disaster Recovery Planning 243 Chapter 18 Implementation Concerns 254

Chapter 19 A Process Redesign Approach to Successful IT Implementation 267

PART V PROFESSIONAL NURSING INFORMATICS

Chapter 20 Nursing Informatics Education: Past, Present, and Future 280

Chapter 21 The Future for Nurses in Health Informatics 292

APPENDICES

Appendix A Generic Request for Proposal 307

Appendix B Nursing Informatics Special Interest Groups 310 Appendix C Sources of Additional Healthcare Informatics

Information 313

Appendix D Professional Societies 316

Appendix E Academic Informatics Programs Worldwide 318 Appendix F Transforming Clinical Documentation: Preparing Nursing

for Change 327

Appendix G Research Databases of Interest to Nurses 333 Glossary 340

Index 357

Contributors

James Cato

Chief Nursing Officer, Eclipsys Corporation, Boca Raton, FL 33487, USA

Ann Casebeer, BA, MPA, PhD

Associate Professor, Department of Community Health Sciences;

Associate Director, Centre for Health and Policy Studies; Faculty Director, AHFMR SEARCH Program, University of Calgary, Calgary, Alberta T2N 1N4, Canada

H´el`ene Cl´ement, RN, BScN, MHA

Vice President, Canadian Operations, GRASP Systems International Companies, Richmond Hill, Ontario L4C 9Y5, Canada

Jane Curry

Information Architect, Health Information Strategies, Inc., St. Albert, Alberta T8N 6M5, Canada

Linda Dietrich, MSN, RN

Director, Practice Transformation, Clinical Practice Model Resource Center, a Subsidiary of Eclipsys Corporation, Grand Rapids, MI 49509, USA

Diana Domonkos

Healthlink, an IBM company, Houston, TX 77098, USA

Judith V. Douglas, MA, MHS

Adjunct Faculty, Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA

Craig Edwards, CIO

Margaret J.A. Edwards & Associates, Calgary, Alberta T2W 2A6, Canada

xiii

xiv Contributors Richard S. Hannah, PhD

Professor Emeritus, Faculty of Medicine, University of Calgary, Calgary, Alberta T2N 1N4, Canada

Eleanor Callahan Hunt, RN, MSN, BC

Clinical Informatics, EMR Solutions R&D, Misys Healthcare Systems, Raleigh, NC 27615, USA

Rebecca Rutherford Kitzmiller, RN, MSN, MHR, BC

Director of Nursing Informatics, Duke University Health System, Durham, NC 27710, USA

Jo Ann Klein, MS, RN-C

Forum Manager, The Nursing Network Forum; Member, Curriculum Committee, Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA

Susan K. Newbold, MS, RNBC, FAAN, FHIMSS

Lecturer in Nursing, Vanderbilt University School of Nursing, Nashville, TN 37203, USA

Paul E. Pancoast, MD

Senior Manager, Clinical Specialist, Deloitte Consulting LLC, Austin, TX 78701, USA

Helen Lee Robertson, MLIS

Document Delivery/Liaison Librarian, University of Calgary, Calgary, Alberta T2N 1N4, Canada

Joyce Sensmeier

Vice President of Informatics, HIMSS, Chicago, IL 60611, USA

Sara Breckenridge Sproat, RN, MSN, BC

Lieutenant Colonel, US Army Nurse Corps, Deputy Director, Division of Regulated Activities, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA

Carole Stephens

Coustal Physician Services, Durham, NC 27705, USA

Lorraine Toews, MLIS

Head, Public Services, Health Sciences Library, University of Calgary,

Calgary, Alberta T2N 1N4, Canada