Nursing Informatics in Canada 

"Registered nurses need to be able to demonstrate their unique contribution 

to the health of Canadians within Canada's rapidly evolving health care system. 

Basic, essential nursing information is required by nurses, employers,

researchers, educators, policy makers, and clients so that informed decisions can be

made about nursing's role in the changing health care system,”.

Canadian Nurses' Association, 1993: Policy Statement on

Health Information

The Canadian Nurses’ Association wrote this policy statement to highlight the importance of developing the nursing data components that will be included in

their emerging national health information system. The CNA has also spearheaded an initiative, the National

Nursing Informatics Project, to begin to develop a national consensus on definition, competencies, and

educational strategies and priorities.

Brief History

“Nurses in Canada have made an enormous contribution to all aspects of Canadian society. Their involvements have influenced the wider social, economic and political history of Canada, as well as the history and politics of health care. Nursing history provides the public with valuable perspectives on emerging technologies, health care reform and gender issues in Canadian history” (Canadian Nurses Association, 2004, p. 2).

Jeanne Mance (1606-1673)

founded the first hospital in

Montreal, Canada in 1642. Various

forms of machinery such as ventilators and physiological

monitors were first used in intensive and critical care

settings.

By the late 1980s, most hospitals had at least a rudimentary information system that required nurses

to enter common data such as

admission profiles and basic care

requirements like diet, medications,

and treatments into a computer as part of their routine duties.

It begins to develop a national consensus on definition,

competencies, and educational strategies and priorities in

nursing informatics develop.

"In 1998 a national steering committee was formed to

address Nursing Informatics issues and develop strategies to ensure that Registered Nurses

have the competencies required to successfully carry out the

responsibilities of their practice.

The National Nursing Informatics Project

Develop consensu

s on a definition

of Nursing

Informatics for

Canada;

Recommend Nursing

Informatics competencies for entry

level nurses and specialists, managers, educators,

and researchers

Identify curriculu

m implicatio

ns and strategies for both

basic and continuing nursing education

Determine priorities

for implement

ing national nursing

informatics

education strategies.

Each participating organization appointed a nurse expert in Nursing Informatics to a five-member working group to develop and initiate a plan to:

The Nursing Minimum Data Set was the first major Canadian Nurses Association informatics initiative beginning in 1990.

This was in response to the strong conviction that nursing data must be

included in the centralized national health data system being planned by the Canadian

Institute of Health Information (CIHI)

Raising Canadian Nursing Awareness

This publication was a critical overview of the

essential characteristics of the

emerging field of nursing informatics in

Canada. It also introduced a definition of nursing informatics,

formulated by the National Nursing

Informatics Project working group

A key one was published in

the September Nursing Bulletin,

entitled: “What is Nursing

Informatics and why is it so

important?”.

. “Nursing Informatics (NI) is the application of computer science and information science to nursing. NI promotes the generation, management and processing of relevant data in order to use information and develop knowledge that supports nursing in all practice domains” (Canadian Nurses Association, 2001, p.1).

 Canadian Institute for Health Information (CIHI)

CIHI has

described its'

role as: 

Setting

National

standards

for financial, statistical

, and

clinical data 

Setting

National

standards

for health information

technology,

Collecting, processing, and

maintaining health

related

databases and registries

Founded in 1975, and has actively initiated professional protocols for using computer systems in Canadian health care.

It launched the Patron Program. As an individual member based organization, COACH promotes understanding and

effective utilization of information and information technologies within the Canadian Healthcare industry through education,

information, networking and communication.

Canadian Organization for the Advancement of Computers in Health or COACH

 Canadian Nursing Informatics Association (CNIA)

The intent of the study was to describe the current state of:

Informatics education opportunities currently available to students of nursing across the country.

The level of preparedness of nursing faculty to deliver these offerings.

Information and communication technology infrastructure and support for faculty in delivering these offerings.

Opportunities to enhance nursing curricula, faculty preparedness, and ICT infrastructure and support in schools of nursing across Canada.

The CNIA

conducted a study

in 2002 - 2003 on

the Informatics

Educational Needs

of Canadian

Nurses, which was

titled, “Educating

Tomorrow's

Nurses: Where's

Nursing Informatics?”

The Canadian Journal of Nursing Informatics

June Kaminski launched  in 2006,

which invites papers, multimedia, and other

electronic media focused on the diverse

arena of nursing informatics.

MissionProvide a peer -

reviewed venue for Canadian nurses and researchers who work with Nursing Informatics to disseminate their research, essays, reviews, presentations, multimedia and other digital publishable materials on a global scale. They have decided to offer this journal free of charge in order to make informatics research and theory openly available to all Canadian nurses.

The Canadian Nurses Portal Project, Nurse ONE, E-Nursing Strategy

Initial goals of this e-nursing strategy include:

advocating fo

r

nurses' a

ccess to

ICT and th

e

resourc

es require

d

to in

tegra

te IC

T into

nursin

g pra

ctice;

supporting the

development and

implementation of

nursing informatics

competencies among the

competencies required

for entry-to-practice and

continuing competence;

advocating for the involvement of

nurses in decision-making about information technology and information

systems. (Canadian Nursing Association,

2006, p. 10).

“The purpose of the e-nursing strategy is to

guide the development of ICT initiatives in nursing to improve nursing practice

and client outcomes” (Canadian Nurses

Association, 2006, p. 7).

Access – better connectivity in work environment, more access to a variety of computer technologies, e.g. PDAs, hardware, software, station computers.

Competency- ongoing ICT skill development, integration into nursing curriculum.

Participation - “as knowledge workers in this technological age, it is essential that nurses play an increased role in the development of ICT solutions” (Canadian Nursing Association, 2006, p. 15).

The e-nursing strategy will address these goals by adopting a three pronged approach:

Learning activities which include:

1.a Cognitive, ("to know" or

epistemological),

2.an Interactive, ("to do"

or ontological) as well as

3.a Reflective, ("to be" or phenomenol

ogical)

The curriculum designed to

prepare caring nurses as

"knowledge workers" for the changing economy of

this new millennium.

The assumption is that as students use computers to

manage information in their student role, they will more readily use their critical thinking skills to

learn related applications in their work as

nurses.

Nursing Informatics at Kwantlen Polytechnic University

The main rational for implementing a

greater use of information

technology (IT) in the healthcare

sector is to improve safety and quality,

improve patient outcomes, and at

the same time try to reduce costs of

 healthcare. care.

Nursing Informatics In Europe

The main mission in Europe is to establish stable infrastructure that improves healthcare quality facilitates the reduction of errors and the delivery of evidence based and cost effective care.

Confidence in IT

and competence to use IT

Information about

society services

available to all citizens

Continuity of Care

and Availabili

ty of  Informat

ion.

Three Objectives of National IT Strategy:

The European commission (EC) is a driving force of healthcare

informatics development by funding projects that are all cross-

cultural involving healthcare professional users, educators and

administrators, always three or more countries participating.

IT in the European Union (EU)

Development of Common Terminology for Nursing Practice in Europe

The common factors that may have contributed are the

increasing cost constraints in the mostly publicity financed

healthcare systems, which have raised demands for cost-effective

care and quality improvement.

International Council of Nurses (ICN)

ICN has initiated the

development of the

ICNP, which has been

translated into at least

12 European languages

and tested in several

countries.

The method of concept and information modeling has been carried out in many countries during the last

decennium. The model was divided into three parts:

Concept and Process ModelingCore

Process- which is

the clinical process

in healthcar

e.

Management

Process- which

monitors and

evaluates the

clinical process

based on the

mandate to

provide healthcar

e. 

Communication

Process- dealing

with information and

interaction with

the surrounding world

as documen

ts or message

s.

Implementation of IT in Healthcare

The tradition of participatory design, when developing applications, is created

a tradition for user involvement and participation that has impact not only on design, but also on project management

and implementation

Organizational ImplementationProject Management

The organizational implementation is more

about how the application supports planed and

wanted changes in work flow and organizational

structure

Project teams are mostly selected to be

representatives of different categories of

clinicians and organizational parts of

the healthcare enterprise.

Clinical and Nursing Implementation

Variety of views on data- appears

to be a very attractive

advantage.

Structures of  data- is

important if data are to be

reused and presented in

several different ways.

Decision support- is

advantageous if the clinician

enters the data

Supports of other data

analysis- may prove an important feature or

quality control, quality

improvement, and resource management.

Electronic data exchange and sharing care

support- assumes reused of data.

Future development needed for nursing

informatics in Europe is implementation of

decision support systems, integration

of research-based knowledge in patient records, and feedback of clinical experience by aggregated data

from patient records.

Future Development

Nursing Informatics in Pacific Rim

The evolution of  NI has varied in each the pacific rim countries. The adoption of informatics usually began as a vision of one or more individuals. Events external to the nursing profession frequently became the catalysts stimulating some type of activity by nurses toward the adoption of informatics

Health and Nursing Informatics in New Zealand

New Zealand's total population is just over 4 million. These people are predominantly found in the urban areas, with the greater Auckland area having over the third of the total population. The hub labeled " Informatics Influences" represents information collection, since this is seen as central to nursing, informatics and healthcare. The other and entities identified are significant layers in new zealands healthcare system, which influences NI and its development.

New Zealand Health Informatics Groups

There are a number of informatics interest groups in New Zealand, each with a slightly

different focus. Health Informatics New Zealand (HINZ) is a national, not-for-profit

organization who's focus is to facilitate improvement in business processes and patient care in the health sector through

the application of the appropriate information technologies. HINZ, a new

organization, emerge in September 2000 from two health informatics organizations.

Australia is the federation of eight state and territories. It has a population of just fewer than

20 million. As a consequence of the globalization of the profession, Australia's

contribution to international education, the resultant work

force mobility, economic growth, and changes in healthcare

industry resulting from technology and informatics advances, changes or being witness in the nursing work

force.

Health and Nursing Informatics in Australia

Australia has had a representative to

IMIA's working group 8(WG8) (now NISIG) since 1984. Nurses

were the second group of health professionals to

organize themselves to promote health

informatics in Australia.

Health Informatics Groups in Australia

Computers were first introduced into the healthcare sectors of Asian counties in the 1970s. The first applications of information technology in healthcare in Asian countries were in administration, billing, and insurance. Now these countries are moving toward implementing paperless electronic health records. 

Nursing Informatics in Asia

Nursing Informatics in Hongkong

Hongkong nurses established NURSINFO (HK) in 1991, and this organization has enjoyed a consistent increased

in membership. They have as their motto " Nursing Informatics for excellence in patient care."  They organize

regular educational activities, use a communication network, produce a regular news letter, and are actively

involve with the Hongkong society of medical informatics and Hongkong computer society.

Hospital

27% implemente

d information

systems

9% were developing information

systems

Long term care institutes:• 50% were not planning to make any investments in nursing information

systems• 19% installed information systems

Taiwan

Nursing Informatics EducationC

ompu

ter-

assi

sted

inst

ruct

ion

prog

ram

s ha

ve

been

dev

elop

ed b

y

the

Min

istr

y of

Edu

catio

n fo

r

nurs

ing

voca

tiona

l

educ

atio

n pr

ogra

ms

sinc

e 19

86.

Online courses are

available for

baccalaureate programs

in counseling, te

aching

principles and stra

tegies,

and long-te

rm care. 

Some schools provide

multimedia self-testing systems. 

Schools provide an

environment with

simulated patients for

students to practice

before taking the test.

NI research is still at its infancy in Taiwan, with only around 40 papers published in domestic

nursing journals in the period 1994-2003. The first formal academic association on NI was set up in

2004, when NI working group was organized within Taiwan association of Medical Informatics, which

had been established in 1991. Standardized terminology such as existing diagnosis

classification systems and the ICNP have been translated for clinical use, and test of their

reliability and validity have been proposed in Taiwan. 

Nursing Informatics Research

Computerized care plans are now common in clinical use

Decision support

systems to test the integration

of medical diagnoses and

nursing diagnoses, and expert systems implemented on PDAs for

the emergency triage system

have been reported.

Patient classification systems have

also been applied for

patient assessment,

nursing interventions,

and staff workload

assignments.

A national “e-Taiwan”

program has been promoted by the Ministry

of Health to promote the

development of health

informatics in Taiwan since

2002

The nursing Informatics Special Interest Group with 20 hospital nurses was founded as a branch of the CMIA in 1991. The first article referring to

the term “nursing information science” appeared in China in 1999, and this led to the application of

information technology in the field of nursing science for education and research. The term NI was first used in the Chinese literature in 2002.

HISTORY OF NURSING INFORMATICS IN CHINA

Nursing Informatics PracticeThe use NI in clinical practice in China includes nursing quality

management, nursing information management, and training clinical skills for staff

nurses. The major weakness of nursing information

management systems in China is the lack of national standards and the low level of computer literacy and informatics skill

exhibited by nurses. 

The healthcare delivery system in Japan provides access to healthcare. Financial contribution to health insurance is

proportional to their income. Families pay 20-30%, respectively, of all health expenditures, and the publicly funded health insurance pay the rest when a patient receives medical

treatment in a hospital.The total health expenditure of Japan remains lower than that in some other advances nations, partially attributable to healthier

dietary habits.The relatively small number of healthcare professionals in the country also help lower the expenditures.

Japan

1970s- Japan began to pay attention to the use of

computers in healthcare.

1980-the Japanese association if medical informatics (JAMI) was

founded at that time with the aim of supporting health informatics in

Japan.

Health Informatics in Japan

Initially research was focused on computerized billing systems for

medical fees and the development of the use of personal computers at an

individual level.The focus then shifted to

research and development of systems at an organizational

level.

1980- the third international congress on medical informatics

MEDINFO80, organizes by IMIA, was held in Tokyo.

1990s- nursing education in Japan rapidly shifted to a more academic orientation

2000s - The nursing division of JAMI was established

The Japanese Nurses Association prepared a

course on nursing information management

as a first step of a continuing curriculum for

ward managers.

Barriers to development of NI continue to remain:

South KoreaUse of Information

Technology in Clinical Practice

Picture Archiving and Communication Systems

(PACSs)

-enables physician to communicate with other departments for practice-related requisitions and

the retrieval of data.

-one of the most common information

technology systems in south Korean

hospitals.

These systems allowed physician to enter medical

orders directly into the computer, and

major ancillary departments could

receive requisitions and

enter test results.

Higher nursing education was introduced in 1983, at least one computer course is required at level, and

nursing students can select other computer courses as elective courses.

Health informatics in South Korea has grown considerably in recent years, with the professional outreach activities of the Korean Society of Medical Informatics (KOSMI) as well as with the help of the

government, private business, academic institutions and medical and nursing organization.

Nursing Informatics Education in South Korea

Teleconsultation - allow a generalists doctor at a health center

in a remote area to have a telepathology or a teleradiology

consultation with the specialist of a tertiary hospital.

Technology Trends

In Thailand, they have the Universal Healthcare Covery Policy to improve the quality and access to services. They want services to be available to all so they established computer systems in

different places for better communication of services. This is supported by the Nurses

Association of Thailand, World Health Organization, and the Ministry of Health.

Thailand

NURSING INFORMATICS IN SOUTH AMERICA

Nursing Informatics in South America has

been based more on ACTIVITIES of

INDIVIDUALS than on a policy established by

governments or national efforts.

Each country in South America has varied levels

of development and deployment of

technological resources.

The use of Technology has visible tendency in:

Health

Nursing Education

Nursing Practice

Nursing Research

Administration

TECHNOLOGY

COMPUTERS NURSING

Are considered an important tool to help nurses take care of

patients and to recognize nursing service and nursing

education.The growth of information technology in Latin

America and the Caribbean has been consistently the

world’s highest for 20 years.

Has been identified around the world as an emerging

profession for over 100 years.

Nurses were considered as the primary users of technology in healthcare

(Safran, Slack and Bleich 1989).

Historically nurses are used to facing challenges, adapting new tools in to the practice to improve their performance.

Creating new models to enhance patient care.

Is the key element for decision making process in

the healthcare area. The more specific information in

place to support clinical decisions, the better care

can be delivered to the patient.

Plays an important role in facilitating access to

the information because for the

information to be useful and meaningful, it has to be timely. There is a

clear trend in the direction of the

computerization of health records.

INFORMATION

TECHNOLOGY

The initial motivation to develop computer systems in

the healthcare area was driven by financial and

administration concerns.The hospital sector can be

considered the area better served by information

systems. Brazil, Mexico, Argentina, Colombia, Chile and Paraguay have clinical

information systems in hospitals or health institutes.

Patient data that are also used for nursing administration are integrated in the systems or nurses have to collect and

analyze nursing data separately

NURSING INFORMATICS INITIATIVES IN SOUTH AMERICA

Hospitals have been working to design their own systems in order to attend to specific

needs and policies.

National and International software become more represented in South America health

care workers.

They provide a broader range solutions with systems that address patient care

documentation.

Technology is transferring not only nursing practice but also nursing training and education models.

Nurses became the primary users, responsible for data input. Nurses become “Computer-Literate” in ordere to use computer technology in a efficient manner.

To meet education and training need, nursing schools and hospitals initiated programs to prepare nurses to use hospital initiated programs to prepare nurses to use computers.

DISTANCE LEARNING AND EDUCATIONAL PERSPECTIVE IN NURSING INFORMATICS

Nucleo de Informatica em Enfermagem at the Universidade Federal De Sao Paulo was

the first center to offer the specialization degree certificate in South America.

NIEn/UNIFESP

Sharing and communicating information is essential to make

decisions and deliver care.

The language includes an alphabets, words, phrases and symbols that

express and assign meaning, understood by all users (PAN

America Health Association/World Health Organization, 1997).

Nursing Terminologies & Documentation

CLARK (1995)

Pointed out that communicating among ourselves has always been important but communicating with other people

about nursing has acquired a new urgency since we are forced to

recognize that the value of nursing is no longer apparent to those who have

the power to influence our practice.

containmentPolicies

Reimbursement

Technological

Development

Other issues to be considered:

In 1990, the International Council of Nurses (ICN) initiated a long term project to develop an international

classification for Nursing Practice with the objective to establish a common

language about nursing practice to be used for describing nursing care for

people in variety of setting (Mortensen, 1996)

In Brazil, the dissemination of the International Classification for Nursing

Practice (ICNP) started around 1996 when NIEn/UNIFESP became a

sponsoring partner in the Telenurse Consortium, led by Randi Mortensen –

director of the Danish Institute for Health and Nursing research.

Home Health Care Classification (HHCC)

developed by Saba 1992 is available on the internet in

Brazilian Portuguese version.

The recommendations from the experts that are merged into this text book edited by

the Division of Systems at PAHO.

Was published in English and Spanish and

distributed to universities, professional

organization and technical cooperation

agencies.

BUILDING STANDARDS-BASED NURSING INFORMATION SYSTEM