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Nursing and Computers: An Anthology, 1987–1996 PDF

700 Pages·1998·13.85 MB·English
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Computers and Medicine Helmuth F. Orthner, Series Editor Springer New York Berlin Heidelberg Barcelona Budapest Hong Kong London Milan Paris Santa Clara Singapore Tokyo Computers and Medicine Use and Impact of Computers in Clinical Medicine James G. Anderson and Stephen J. Jay (Editors) Information Systems for Patient Care Bruce I. Blum (Editor) A Clinical Information System for Oncology John P. Enterline, Raymond E. Lenhard, Jr., and Bruce I. Blum (Editors) The PACE System: An Expert Consulting System for Nurses Steven Evans Evaluation Methods in Medical Informatics Charles P. Friedman and Jeremy C. Wyatt (Editors) HELP: A Dynamic Hospital Information System Gilad J. Kuperman, Reed M. Gardner, and T. Allan Pryor Expert Critiquing Systems Perry L. Miller Selected Topics in Medical Artificial Intelligence Perry L. Miller (Editor) Implementing Health Care Information Systems Helmuth F. Orthner and Bruce I. Blum (Editors) Computer-Assisted Medical Decision Making, Volume 1 James A. Reggia and Stanley Tuhrim (Editors) Computer-Assisted Medical Decision Making, Volume 2 James A. Reggia and Stanley Tuhrim (Editors) Nursing and Computers: An Anthology, 1987-1996 Virginia K. Saba, Dorothy B. Pocklington, and Kenneth P. Miller (Editors) Nursing and Computers: An Anthology Virginia K. Saba, Karen A. Rieder, and Dorothy B. Pocklington (Editors) (continued after index) Virginia K. Saba Dorothy B. Pocklington Kenneth P. Miller Editors Nursing and COlllputers An Anthology, 1987-1996 With 45 Illustrations , Springer Virginia K. Saba, EdD, RN, FAAN, Dorothy B. Pocklinglon, MSN, RN FACMI 10061 Century Drive 2332 South Queen Street Ellicott City, MD 21042, USA Arlington, V A 22202, USA Kenneth P. Miller, PhD, RN, FAAN Series Editor: 8014 Crabtree Place Helmuth F. Orthner, PhD Gaithersbury, MD 20879, USA Professor of Medical Infonnatics University or Utah Health Sciences Center Salt Lake City, UT 84132, USA Library of Congress Cataloging-in-Publication Data Nursing and computers: an anthology, 1987-19961 [edited by] Virginia K. Saba, Dorothy B. Pocklington, Kenneth P. Miller. p. cm.--{Computers and medicine) An anthology of selected classical articles and published papers on nursing informatics. Includes bibliographical references. ISBN -13:978-1-4612-7448-3 e·ISBN·I3: 978·1-4612·2182·] 001: 10.10071978-1-4612-2182-1 I. Nursing infonnatics. 2. Nursing-Data processing. I. Saba, Virginia K. II. PocklinglOn, Dorothy B. III. Miller. Kenneth. 1948--. IV. Series: Computers and medicine (New York, N.Y.) [DNLM: I. Nursing-collected works. 2. Medical Infonnatics-rollected works. WY 26.5 N9735 I997J RT50.5.N863 1997 61O.73'0285--<1c21 97-12462 Printed on acid·free paper. {;I 1998 Springer· Verlag New York. Inc. Softcover reprint of the lIardcover 1 5t edition 1998 All rights reserved. This work may not be translated or copied in whole or in part without the wriHcn permission of thc publisher (Springer-Verlag New York. Inc. . 175 Fifth Avenue, New York. NY 10010. USA), e)(cept for brief e)(cerpts in connection with reviews or scholarly analysis. Usc in connection with any form of information storage and retrieval. electronic adaptation. computer software. or by similar or dissimilar methodology now known or hereaf ter developed is forbidden. The use of general descriptive names, trade names, 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. While the advice and information in this book arc 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, e)(press or implied. with respect to the material contained herein. Production coordinated by Chernow Editorial Services. Inc .. and managed by Terry Kornak:; manufacturing supervised by Joe Quatela. Typeset by BeSHet TypeseHer Ltd" Hong Kong. 9 8 7 6 5 4 321 ISBN-13:978-1-46l2-7448-3 Springer' Verlag New York Berlin Heidelberg SPIN 10552813 Series Preface This monograph series intends to provide medical information scientists, health care administrators, physicians, nurses, other health care providers, and computer science professionals with successful examples and experi ences of computer applications in health care settings. Through these com puter applications, we attempt to show what is effective and efficient, and hope to provide guidance on the acquisition or design of medical informa tion systems so that costly mistakes can be avoided. The health care provider organizations such as hospitals and clinics are experiencing large demands for clinical information because of a transition from a "fee-for-service" to a "capitation-based" health care economy. This transition changes the way health care services are being paid for. Previ ously, nearly all health care services were paid for by insurance companies after the services were performed. Today, many procedures need to be pre approved and many charges for clinical services must be justified to the insurance plans. Ultimately, in a totally capitated system, the more patient care services are provided per patient, the less profitable the health care provider organization will be. Clearly, the financial risks have shifted from the insurance carriers to the health care provider organizations. In order for hospitals and clinics to assess these financial risks, management needs to know what services are to be provided and how to reduce them without impacting the quality of care. The balancing act of reducing costs but maintaining health care quality and patient satisfaction requires accurate information of the clinical services. The only way this information can be collected cost-effectively is through the automation of the health care pro cess itself. Unfortunately, current health information systems are not comprehensive enough and their level of integration is low and primitive at best. There are too many "islands" even within single health care provider organizations. With the rapid advance of digital communications technologies and the acceptance of standard interfaces, these "islands" can be bridged to satisfy most information needs of health care professionals and management. In v vi Series Preface addition the migration of health information systems to web-based client! server computer architectures allows us to re-engineer the user interface to become more functional, pleasant, and also responsive. Eventually, we hope, the clinical workstation will become the tool that health care pro viders use interactively without intermediary data entry support. Computer-based information systems provide more timely and legible information than traditional paper-based systems. In addition, medical in formation systems can monitor the process of health care and improve quality of patient care by providing decision support for diagnosis or therapy, clinical reminders for follow-up care, alerts about adverse drug interactions, alternatives to questionable treatments, or warnings to devia tions from clinical protocols, and more. The complexity of the health care workplace requires a rich set of requirements for health information sys tems. Further, the systems must respond quickly to user interactions and queries in order to facilitate and not impede the work of health care pro fessionals. Because of this and the requirement for a high level of securi ty, these systems can be classified as very complex and, from a develop er's perspective also as "risk" systems. Information technology is advancing at an accelerated pace. Instead of waiting for three years for a new generation of computer hardware, we are now confronted with new computing hardware every 18 months. The forth coming changes in the telecommunications industry will be revolutionary. Within the next five years, and certainly before the end of this century, new digital communications technologies, such as the Integrated Services Digi tal Network (ISDN), Asynchronous Data Subscriber Loop (ADSL) tech nologies, and very high speed local area networks using efficient cell switching protocols (e.g., A TM), will not only change the architecture of our information systems but also the way we work and manage health care institutions. The software industry constantly tries to provide tools and productive development environments for the design, implementation, and mainte nance of information systems. Still, the development of information sys tems in medicine is an art, and the tools we use are often self-made and crude. One area that needs desperate attention is the interaction of health care providers with the computer. While the user interface needs improve ment and the emerging graphical user-interfaces form the basis for such improvements, the most important criterion is to provide relevant and accurate information without drowning the physician in too much (irrel evant) data. To develop an effective clinical system requires an understanding of what is to be done and how to do it, and an understanding of how to integrate information systems into an operational health care environment. Such knowledge is rarely found in anyone individual; all systems described in this monograph series are the work of teams. The size of these teams is usually small, and the composition is heterogeneous, i.e., health profession- Series Preface vii als, computer and communications scientists and engineers, statisticians, epidemiologists; etc. The team members are usually dedicated to working together over long periods of time, sometimes spanning decades. Clinical information systems are dynamic systems; their functionality constantly changing because of external pressures and administrative changes in health care institutions. Good clinical information systems will and should change the operational mode of patient care which, in turn, should affect the functional requirements of the information systems. This interplay requires that medical information systems be based on architec tures that allow them to be adapted rapidly and with minimal expense. It also requires a willingness by management of the health care institution to adjust its operational procedures, and, most of all, to provide end-user education in the use of information technology. While medical information systems should be functionally integrated, these systems should also be modular so that incremental upgrades, additions, and deletions of modules can be done in order to match the pattern of capital resources and invest ments available to an institution. We are building medical information systems just as automobiles were built early in this century, i.e., in an ad~hoc manner that disregarded even existing standards. Although technical standards addressing computer and communications technologies are necessary, they are insufficient. We still need to develop conventions and agreements, and perhaps a few regula tions that address the principal use of medical information in computer and communication systems. Standardization allows the mass production of low cost parts that can be used to build more complex structures. What exactly are these parts in medical information systems? We need to identify, classify, and describe them; publish their specifications; and, most impor tantly, use them in real health care settings. We must be sure that these parts are useful and cost effective even before we standardize them. Clinical research, health services research, and medical education will benefit greatly when controlled vocabularies are used more widely in the practice of medicine. For practical reasons, the medical profession has developed numerous classifications, nomenclatures, dictionary codes, and thesauri (e.g., lCD, CPT, DSM, SNOMED, LOINC, COSTAR dictionary codes, BAlK thesaurus terms, and MESH terms). The collection of these terms represents a considerable amount of clinical activities, a large por tion of the health care business, and access to our recorded knowledge. These terms and codes form the glue that links the practice of medicine with the business of medicine. They also link the practice of medicine with the literature of medicine, with further links to medical research and edu cation. Since information systems are more efficient in retrieving informa tion when controlled vocabularies are used in large databases, the attempt to unify and build bridges between these coding systems is a great exam ple of unifying the field of medicine and health care by providing and using medical informatics tools. The Unified Medical Language System viii Series Preface (UMLS) project of the National Library of Medicine, NIH, in Bethesda, Maryland, is a prime example of such an effort. The purpose of this series is to capture the experience of medical infor matics teams that have successfully implemented and operated medical information systems. We hope the individual books in this series will con tribute to the evolution of medical, nursing, or health informatics as a rec ognized professional discipline. We are at the threshold where there is not just the need but already the momentum and interest in the health care and computer science communities to identify and recognize the new disci pline called Medical Informatics. I would like to thank Springer-Verlag New York for the opportunity to edit this series. Also, many thanks to the present and past departmental chairmen who allowed me to spend time on this activity: William S. Yamamoto, MD and Thomas E. Piemme, MD, of Department of Computer Medicine at The George Washington University Medical Center in Washington, DC, and Homer R. Warner, MD, PhD, and Reed M. Gardner, PhD, of the Department of Medical Informatics at the University of Utah Health Sciences Center in Salt Lake City, Utah. Last but not least I thank all authors and editors of this monograph series for contributing to the practice and theory of Medical Informatics. Salt Lake City, Utah HELMUTH F. ORTHNER Preface This anthology consists of selected classical articles and published papers on nursing informatics and is a compendium for maintaining and expanding the knowledge base of computer technology in nursing. It serves as one example of the transition of nursing knowledge of computer literacy as it developed for the profession. The first edition contained articles, published between 1981 and 1986, from nursing journals and proceedings from computer conferences that highlighted the entry of nursing informatics into the technological era. However, this second volume represents landmark documents in the devel opment and progress of nursing informatics, nursing information systems, and other applications using computer technology. This volume contains 87 articles from approximately 20 published sources, such as proceedings, that have not been indexed in the major computer-based health-related bibliographic retrieval systems. As a result, these published papers are not compiled from a computer search of the systems and therefore are not readily available or used to advance nursing informatics and nursing knowledge. The articles encompass a ten-year period from 1987 through 1996. The majority of papers are primarily derived from proceedings, conferences, and workshops, specifically: • Nursing Informatics: NI' 88, NI' 91 & NI' 94 conferences: (Proceedings of the Third, Fourth, & Fifth Conference on Nursing Use of Computers and Information Science sponsored by International Medical Informatics Association, Nursing Informatics (IMIA-NI Special Interest Group) • SCAMC: 1987-1990 (Proceedings of the Eleventh, Twelfth, Thirteenth, & Fourteenth Annual Symposium on Computer Applications in Medical Care) sponsored by the American Medical Informatics Association (AMIA). • AMIA/SCAMC: 1991-1996 (Proceedings of the Fifteenth, Sixteenth, Seventeenth, & Eighteenth ix x Preface Annual Symposium on Computer Applications in Medical Care) spon sored by the American Medical Informatics Association (AMIA). • Medical Informatics: MEDINFO' 89, MEDINFO' 92, & MEDINFO' 95 congresses: (Proceedings of the Sixth, Seventh, & Eighth World Congress on Medical Informatics sponsored by the International Medical Informatics Asso ciation (IMIA). • Medical Records Institute: 1988-1996 (Proceedings of the Annual Symposium entitled Toward an Electronic Patient Record sponsored by the Medical Records Institute. • Selected papers from other sources and conferences that focused on Nursing Informatics such as Annual National Nursing Computer Conference sponsored by Rutgers, the State University of New Jersey College of Nursing Continuing Education Program. Initially all nursing articles in the above publications were selected for review by the three editors who were responsible for: • Categorizing the articles into one of five topical areas: (1) general informatics, (2) clinical practice, (3) nursing administration, (4) nursing research, and (5) nursing education. • Identifying the specific focus and topic for each article. • Evaluating and prioritizing each article. • Presenting, discussing, and reviewing each article in a group forum. • Selecting and assigning each article to one editor for an introduction to one of the five sections of the book. The articles represent milestones as new nursing experts entered the field of nursing informatics. This book will help to ensure that the effort expended in the preparation of the articles is used to enhance and advance nursing knowledge of nursing informatics. This second volume is divided into five major sections: (1) General Informatics, (2) Clinical Practice, (3) Nursing Administration, (4) Nursing Research, and (5) Nursing Education; each with its own introduction that highlights its selections, authors, and focus. VIRGINIA K. SABA DOROTHY B. POCKLINGTON KENNETH P. MILLER

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Nursing and Computers: An Anthology 1987-1996 is a compilation of both landmark historic and contemporary papers, illustrating the inception and evolution of nursing informatics. The editors have collected these newly-published independent papers, and assembled them into an invaluable source book pr
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