Health Informatics. Kathryn J. Hannah Marion J. Ball Series Editors. Springer Science+ Business Media, LLC. (formerly Computers in Health Care)

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1 Health Informatics (formerly Computers in Health Care) Kathryn J. Hannah Marion J. Ball Series Editors Springer Science+ Business Media, LLC

2 Health Informatics (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 Aspects of the Computer-based Patient Record M.J. Ball and M.F. Collen Nursing Informatics Where Caring and Technology Meet, Second 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 Introduction to Medical Informatics P. Degoulet and M. Fieschi Patient Care Information Systems Successful Design and Implementation E.L. Drazen, J.B. Metzger, J.L. Ritter, and M.K. Schneider Introduction to Nursing Informatics, Second Edition K.J. Hannah, M.J. Ball, and M.J.A. Edwards Computerizing Large Integrated Health Networks The VA Success R.M. Kolodner Organizational Aspects of Health Informatics Managing Technological Change N.M. Lorenzi and R.T. Riley Transforming Health Care Through Information Case Studies N.M. Lorenzi, R.T. Riley, M.J. Ball, and J.V. Douglas (continued after Index)

3 Kathryn J. Hannah Marion J. Ball Margaret J.A. Edwards Introduction to Nursing Informatics Second Edition With 47 Illustrations Springer

4 Kathryn J. Hannah, PhD, RN Vice President, Health Informatics Sierra Systems Consultants, Inc. Calgary, Alberta T3B ZA6 and Professor, Department of Community Health Science Faculty of Medicine University of Calgary Calgary, Alberta TZN 4Nl, Canada Marion J. BaU, EdD Professor, Department of Epidemiology University of Maryland School of Medicine and Vice President First Consulting Group Baltimore, MD ZIZ01, USA Margaret J.A. Edwards, PhD, RN Margaret J.A. Edwards and Associates, Inc. 5Z Cordova Road SW Calgary, Alberta T2W ZA6, Canada Series Editors: Kathryn J. Hannah, PhD, RN Marion J. BaH, EdD Library of Congress Cataloging-in-Publication Data Hannah, Kathryn J. Introduction to nursing informatics/kathryn J. Hannah, Marion J. BaU, Margaret J.A. Edwards.-Znd ed. p. cm.-(health informatics series) Inc1udes bibliographical references and index. ISBN ISBN (ebook) DOI / Nursing informatics. 1. BaU, Marion J. II. Edwards, Margaret J.A. III. Title. IV. Series: Health informatics (New York, N.Y.) [DNLM: 1. Information Systems nurses' instruction. Z. Nursing. WY 26.5 H ] RT50.5.H O.73'OZ85-dcZl Printed on acid-free paper. 1999, 1994 Springer Science+Business Media New York OriginaUy published by Springer-Verlag New York, Inc. in 1999 Softcover reprint of the hardcover Znd edition 1999 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, LLC, 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 of general descriptive narnes, trade narnes, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. Wbile the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Production coordinated by Chernow Editorial Services. Inc., and managed by Victoria Evarretta; manufacturing supervised by Thomas King. Typeset by Best-set Typesetter Ltd., Hong Kong Z 1 ISBN SPIN

5 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, Alexis Marion Concordia, Michael John Concordia, Erica Adelaide Concordia, Alexander John Ball, Ryan loki Ball, Maryn Joy Edwards, and John Kurt Edwards.

6 Series Preface This series is directed to health care professionals who are leading the transformation of health care by using information and knowledge. Launched in 1988 as Computers in Health Care, the series offers a broad range of titles: 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 health care 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 next millennium. By making full and creative use of the technology to tame data and to transform information, health informatics will foster the development of the knowledge 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

7 Preface The first book in the Computers in Health Care series, Nursing Informatics: Where Caring and Technology Meet, was published more than a decade ago. Both editions have provided experienced nurse informaticians with a detailed discussion of advanced concepts in nursing informatics. Since the publication of that book, we have been repeatedly asked by those who want to enter this exciting field, "How do we get started in Nursing Informatics?" This book in its first edition was the answer to that question. This new edition continues to address this same question. 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 first edition from readers. The book has been completely reorganized and restructured. New material has been added and new information incorporated. The book introduces terms and concepts foundational to nursing informatics as well as provides an introduction to the Internet. An overview of nursing use of Information Systems is provided. The book includes an exploration of the most common applications of nursing informatics in clinical nursing practice (both community- and facility-based 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 informatics 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 Information 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 ix

8 x Preface strategies, and to use the more advanced volumes in the Springer-Verlag senes. Nursing Administrators: to familiarize themselves with the field of nursing informatics in preparation for implementing computerized solutions for information management in their institutions. The practical guideline will assist the manager in making informed decisions regarding system selection/development, implementation, and use. Reference: to involve nursing unit managers and staff in the implementation 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 application information provided would help them to facilitate implementation and use of the computer application. We believe that this book 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 excitement of nursing informatics and share our enthusiasm for this rapidly evolving field. Kathryn J. Hannah Marion J. Ball Margaret J.A. Edwards

9 Florence Nightingale at the Keyboard

10 Florence Nightingale at the Keyboard Concept: MARYANN F. FRALIC, RN, DrPH, FAAN, The Johns Hopkins University School of Nursing Visualization: BARBARA FRINK, RN, PhD, FAAN, The Johns Hopkins Hospital Production: The Johns Hopkins University School of Medicine, Department of Pathology To win support for her work in the Crimean War, Florence Nightingale analyzed statistics and drew diagrams to illustrate the impact of nursing on soldiers' mortality. An early nurse researcher, she modeled and presented outcomes data in a simple and straightforward way, without modern information technology. Think what she would have done with a high-powered PC and a fast modem! Think of what she could have accomplished! Today we have incredible information technologies available to us. It is our responsibility as nurses to use these tools wisely, on behalf of our patients and our profession. We have the tools, and we have the template and the legacy that Florence Nightingale gave us. Our challenge now is to creatively blend the two for the next generation of nursing practice, shaping the future of nursing education, nursing research, nursing management, and-<:entrally-<:linical nursing care. Nursing informatics holds the capabilities and competencies we need-to track and measure outcomes, to support decisions, and to create evidencebased practice. And we must master nursing informatics in the era we are entering, the era of telehealth, where we will be "wired health care professionals," linked by computers to people, places, and resources-in a word, "telenurses." Think of what we can do, what we can accomplish! Xll

11 Contents Series Preface vn Preface ix Florence Nightingale at the Keyboard xii Contributors xv PART I FOUNDATIONS OF NURSING INFORMATICS CHAPTER 1 Nurses and Informatics 3 CHAPTER 2 Anatomy and Physiology of Computers 11 CHAPTER 3 History of Health Care Computing 26 CHAPTER 4 Telecommunications and Informatics 39 PART II NURSING USE OF INFORMATION SYSTEMS CHAPTER 5 Enterprise Health Information Systems 53 CHAPTER 6 Nursing Aspects of Health Information Systems 79 PART III APPLICATIONS OF NURSING INFORMATICS CHAPTER 7 Clinical Practice Applications: Facility Based 101 CHAPTER 8 Clinical Practice Applications: Community Based 114 CHAPTER 9 Administration Applications 125 Xlll

12 XIV Contents CHAPTER 10 CHAPTER 11 Education Applications 147 Research Applications 159 PART IV CHAPTER 12 CHAPTER 13 CHAPTER 14 CHAPTER 15 CHAPTER 16 CHAPTER 17 CHAPTER 18 INFRASTRUCTURE ELEMENTS OF THE INFORMATICS ENVIRONMENT Defining Information Management Requirements 171 Selection of Software and Hardware 178 Data Protection 194 Ergonomics 210 Usability 219 Disaster Recovery Planning 227 Implementation Concerns 238 PARTV CHAPTER 19 CHAPTER 20 PROFESSIONAL NURSING INFORMATICS Nursing Informatics Education: Past, Present, and Future 249 The Future for Nurses in Health Informatics 261 APPENDICES APPENDIX A APPENDIX B APPENDIX c Generic Request for Proposal 275 Addresses for Professional Societies 304 Sources of Additional Informatics and Health Care Information 306 APPENDIX D Research Databases of Interest to Nurses 317 APPENDIX E Riley and Saba's Nursing Informatics Education Model: APPENDIX F Basic Computer Content for Undergraduate Students 324 Proposed Nursing Informatics Education Model for Graduate Nursing Informatics Students 325 Glossary 327 Index 345

13 Contributors Steven C. Ball, BA, MSc Consultant, Edmonton, Alberta, Canada Ann Casebeer, PhD Assistant Professor, Department of Community Health Science, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada Judith V. Douglas, MHS First Consulting Group, Baltimore, MD, USA RichardS. Hannah, PhD Director, Canadian Medical Multimedia Development Centre, and Professor, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada JoAnn Klein, RN, MS President, Mid-Atlantic Network Associates, Inc., Reisterstown, MD, USA Kathy Momtahan, RN, PhD Staff Scientist, Network Edge Technology Group, Norte!, Ottawa, Canada Cheryl Plummer, RN, MSc Consultant, Sierra Systems Consultants, Inc., Calgary, Vancouver, British Columbia, Canada XV