NURSING INFORMATICSIN

ASIA

INTRODUCTION

1970’s-computers were first introduced into the

health care sectors of Asian countries

The first applications of IT in health care: Administration Billing Insurance 1980 / early 1990’s-The terms health informatics and NI were introduced 

The history of NI varies between Asian countries:

All governments played a vital role in

introducing information technology in health sectors

Professional organizations also played an important role

 * The adoption of informatics in Asian countries

usually began as a vision by a group of individuals or a professional organization

 

1990’s-Reports of research on NI began to appear in

the domestic Asian nursing journals

Asia Pacific Medical Informatics Association (1993)

-Helped launch national healthcare informatics associations in China, Japan, South Korea, Taiwan and Thailand due to the hosting of tri-annual conferences in the Pacific Rim

 

KOREA

History of Nursing Informatics in Korea

The use of computers began in the late 1970s in hospital finance and administration systems to expedite insurance reimbursements

The terms health informatics and NI were first introduced when the KOSMI was founded in 1987.

Computers were not used in nursing education and research until 1993, and NI was not taught in universities until 1994.

Use of Information Technology in Clinical Practice

The use of computers in clinical nursing practice in Korea began first in medium-sized hospitals.

Major department could receive requisition and enter test results.

The nurses’ work lists could be viewed on screens.

Home healthcare nurses use laptop computers to note and check medication and progress in electronic patient records, and to communicate electronically with other home healthcare team members.

STANDARDIZATION ACTIVITIES There are current efforts to

implement a single, integrated healthcare and nursing terminologies in South Korea, the primary motivation for which is compatibility of data, clinical documentation, and research outcomes across the country.

International Organization for Standardization/Technical Committee 215 (ISO/TC215) and Health Level Seven (HL7) – these are the Korean representative actively involved in several international initiatives

Administrative information systems in the healthcare sector essentially use the Korean Standard Classification of Diseases, while clinician information systems are beginning to use more concept-oriented terminology such as the SNOMED.

GOVERNMENT INITIATIVES

Contribution of the Korean government in the development of health informatics

Provide funding or other incentives Guidelines in telemedicine Emergency medical systems Infectious diseases reporting systems and

standardization Implementation of a nationwide

information highway, with the Ministry of Information and Communication

 

Two information highways available:

South Korea Advanced Research Network

Nationwide commercialized network

The Korean Ministry of Health and Welfare established a long-term plan for a national health and welfare network (NHWN) in 1993.

NHWN covers six areas: Public health – top priority project in

1994 Hospitals and clinics Health insurance Food and drugs National pension Health and welfare administration

PROFESSIONAL OUTREACH KOSMI – played a very important role in

promoting and developing health informatics by holding biannual and academic conferences, various seminars, workshops, open forums, publishing journals and offered educational programs for beginners in health informatics.

Korean Medical Association and the Korean Nurses Association – played significant roles by including health informatics in their continuing education programs.

Health Informatics Standardization Committee – serving as the South Korean technical advisory group of the ISO/TC215, has held open forums and published health information standards.

IMIA – furthering the knowledge of South Korean healthcare professional about worldwide trends in health informatics.

JAPAN

The population of Japan is about 127 million

The healthcare delivery system in Japan provides easy access to health care. All citizens can choose health care institutions and doctors freely, and their financial contribution to health insurance is proportional to their income.

The Japanese government will contribute a maximum of 70,000 yen to the medical treatment of a person over 1 month.

Health Informatics in Japan Japan began to pay attention to the use

of computers in healthcare during the late 1970’s.

The Japanese Association Medical Informatics (JAMI) was founded at that time with aim of supporting health informatics in Japan.

Initially research was focused on computerization billing systems for medical fees, and the development of the use of personal computers at an individual level (JAMI 2004)

Medical information departments in about 50 national university hospitals have made the largest contribution to the development of health informatics in Japan. Each organization has been developing its own hospital information system for its own applications to clinical practice, education, and research.

History of Nursing Informatics in Japan

The third International Congress on Medical Informatics, MEDINFO80, organized by the IMIA, was held in Tokyo in 1980. This congress included a special interest group on NI, which represented the beginning of NI in Japan.

NI was applied more in clinical practice than in academic fields during the 1990’s, with more nurses learning about

utilizing computers in nursing practice through the activities of medical information department settings in the national university hospitals.

The Japanese Nurses Association prepared a course on nursing information management as a first step of continuing education curriculum for ward managers.

Barriers to the development of the NI remain in Japan:

There are few researchers and educators in NI

There is little development of educational tools

The cost of improving the network and computer environments is high.

Nursing Informatics Research The amount of NI research is increasing

in Japan, the two main purposes of which are improving the quality and standardization of nursing practice.

There has also been research into the use of information to prevent nursing-related accidents. Research into nursing practice algorithms using thinking aloud methods have begun in Japan.

Nursing Informatics Practice Becoming a specialist in NI is useful

when hospital information system and electronic health records are introduced. However, the accreditation program of Japan Nursing Association does not recognize the training for such specialist.

The JAMI began an accreditation program for “health-care information technologists” in 2003

Japanese Government Initiatives and Standards Development in Japan

An e-Japan strategy encompassing all Japanese ministries and related agencies is progressing now in Japan. The standardization of medical information is one of the main themes in the healthcare sector.

The ministry of health, Labor, and Welfare announced a grand design for health-care, and set the following achievement goal for 2006

1.EHR will be introduced into 60% of hospitals with more than 400 beds and into 60% of clinics.

2.The electronic health expenditures payment system will be introduced into 70% of all hospitals.

3.About 260 fundamental nursing practices have been indentified and named in Japan.

4.The two hospitals where EHR using this nursing terminology were developed have utilized the terminology describing nursing care plan and nursing order, and in the implementation of care; and differences in the nursing care offered to patients became clear.

CHINA

History of Nursing informatics in China:

1970 - The development of nursing information management systems began in China.

1981- The China Medical Informatics Association was founded.

1987- Nursing information management systems first used.

1991- The Nursing Informatics Special Interest group with 20 hospital nurses was founded as a branch of the CMIA.

A year after - Nursing Department of the Chinese ministry of Health -Its mission being to establish criteria for nursing management and the training of nurse administrators for nursing information management.

1993 - The Chinese society of Medical Information was founded.-holding national academic conferences and seminars, continuing education and training.

1996 - Chinese Hospital Information Management Association was founded. -Holding national and international academic collaborations and exchanges, establishing rules and standards and national hospital management, and training hospital information management staff.

1999 - “Nursing information science” appeared that led to the application of information technology in the field of nursing science for research and education

2001- 120 schools with 3- year diploma programs, 62 schools offering a baccalaureate, and 11 schools with master’s programs.

-Distance learning is also being used for nursing continuing education in China.

The use of NI in clinical practice in China includes nursing quality management, staff 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.

THAILAND

Located in Southeast Asia The country has a population of 65

million living in 67 provinces In 2004, there were 92 regional/general

hospitals, 707 community hospitals, and 9,559 health centres

The government is currently launching a Universal Healthcare Coverage Policy

NI was first introduced as small special interest groups and later expanded to national level

The Development of a Health Information System

Implemented by MOPH in 1997

The former director of the MOPH of Nursing Division, Mrs. Areeya Suppalak, considered it important to provide nurses with the means of using information technology

To develop the ideal nursing minimum data set(NMDS) and a preliminary nursing classification system funding was received from the WHO in 1999 as a result of collaborative effort among the:

-Center for Nursing Research at the Department of Nursing

-The Faculty of Medicine -Ramathibodi Hospital -Mahidol University MOPH Nursing Division

Development of Nursing Minimum Data Set (NMDS)

The first step in developing a nursing information system is to identify an essential NMDS, and here the process of developing an NMDS PECIFIC TO Thailand ids discussed

There were 23 nursing data identified through a survey study that was conducted, these include the ff:

patient name, hospital number, ID number, admission number, patient’s address and phone number, address and phone number of the significant person, gender, age, birth date, religion, education, health insurance, patient and family medical history/allergy, admission date, medical diagnosis, laboratory test, nursing problem, nursing intervention, nursing outcome, discharge/ expired date, discharge plan, condition before discharge, referral, and home visit

NURSING INFORMATION SYSYTEM >A further attempt to implement the

INCP in the Thai nursing environment was the developed, a collaborative software program called “Healthware 2000” by the MOPH on Nursing division for the collection an retrieval of nursing care data.>The unsuccessful implementation of Healthware 2000 lead to the MOPH Division of Nursing further developing standard care plans using the INCP, which were later adapted to computer implementation.—Still in progress.

Dr. Jintana Unipan, leader of Nurses’ Association of Thailand, provided seed money for the development of a database including nursing diagnoses, nursing interventions, and nursing outcomes in 10 leading diagnostic-related groups using beta version of the INCP.

7 Specialty Areas:

Medical nursingSurgical nursingPediatric nursingMaternal and child nursingMental health and psychiatric nursingCommunity nursing and home health careCancer nursing

PROFESSIONAL OUTREACHThai Medical Informatics Society (TMI) – introduced the concept of medical informatics into Thailand.>Currently, TMI has 300 active members>Main Objectives of TMI:

To develop means for the management of medical information in administration and academic areas

To be the center for coordinating and distributing medical information.

To exchange information and experience in medical informatics

To support those who practice Med. Info.

To provide suggestions and recommendations for med. Info sectors both within and outside the MOPH

To not be involved in any commercial nor political activities

The Main activities of TMI: Holding an annual conference Supporting the meeting, training and

information sharing for the development of med. Info in Thailand.

Publishing and distributing four issues of documents per year as approved by the board

Being the center for the coordination of the medical info exchanges

Being the center for information and ideas focused on the development of medical info.

>TMI includes a clinical informatics special interest group, a NI special interest groups and a HIS/LIS club.>TNI Activities are:

Holding a joint annual meeting with the Nurses’ Association of Thailand and the Medical Informatics society

Publishing and distributing its newsletter every 4 months

Supporting other academic and research activities in NI

Responding to the NI training needs of Thai nurses.

STANDARDS DEVELOPMENT The development of Thai Nursing

standards is related to the development of the ICNP, although for medicine the ICD 10 has been used in all health service facilities

Since Thai health care system is moving toward a national health insurance policy, The use of a diagnostic-related group classification system is required for reimbursements from the National Health Care Fund.

TAIWAN

History of Nursing Informatics

1990 - Nursing Informatics first used in Taiwan

1980’s - computers had been used in nursing education

1990’s - elective courses in baccalaureate and master’s program had started

All baccalaureate programs included at least one or two computer courses

Nursing Information System in Taiwan

Based on the unpublished results of a 2002 national survey

27% of hospitals had implemented nursing information systems

9% were developing them 24% were making plans to develop

them 40% were not planning to make any

investments in nursing information systems

Nursing Informatics Education Computer- assisted instruction

programs have been developed by the Ministry of Education for nursing vocational programs since 1986.

The content includes: Diet education for diabetic clients, Biostatics, Maternal child health, stress management and patient nutrition

Online courses are available for baccalaureate programs in counseling, teaching principles and strategies And long-term care.

Students are videotaped when tested for nursing skills such as injection and enemas, and the content is sent to the instructors online for grading.

Schools provide an environment with simulated patients for students to practice before taking the test.

At least six graduate programs in health or medical informatics provide informatics trainings at master’s level for students with nursing backgrounds.

Nursing Informatics Research 2004- first formal academic association

was first set up Standardized terminology such as

existing nursing diagnosis classification systems and the ICNP have been translated for clinical use, and tests of their reliability and validity have been proposed in Taiwan

User’s perception and satisfaction toward computer use in daily practice have been analyzed.

Qualitative approaches such as interviews have been used how explore how well nurses will accept the change from manual charting to computerized documentation.

Quantitative approaches such as surveys have been applied to investigate the attitude and satisfaction toward the use of personal digital assistance for charting and the storage of nursing records.

Nursing Informatics Practice Decision support system to test the

integration of medical diagnoses and nursing diagnose, and expert systems implemented by PDAs for the emergency triage systems have been reported.

Patient classification system have been applied for patient assessment, nursing investigations and staff workload assignments.