Unformatted text preview: Introduction to Health
NU234 1 Objectives Define healthcare informatics
Explain the relevance of healthcare informatics and
techno devices for patients, healthcare and the
Describe nursing informatics competencies
Describe the 3 sources of online health information
Define a data warehouse.
Use government sponsored large data warehouses to
locate health related information.
Discuss data mining as a tool to improve health
2 Nursing and Informatics Nurses have always played an important part
in information systems.
Nurses make up the largest group of
healthcare workers using informatics.
Informatics helps the nurse collect, record,
and retrieve patient data.
Some nurses have degrees in healthcare
informatics. Electronic Health Records There are many benefits associated with EHRs.
Benefits to patients: improved safety and quality
of care, electronic accessibility
Benefits to nurses: fewer medical errors, less time
spent charting, electronic decision-making
prompts, ability to monitor compliance
Patient- and population-level data can be
monitored. Health Insurance Portability and
Accountability Act HIPAA requires that patient information
remains private and secure.
Government involvement in implementing
EHRs is accelerating. Incentives are offered for meaningful use of EHR
technology. Nurses need to enhance their knowledge of
informatics. Telehealth and Medical Homes Telemedicine or telehealth involves exchange
of medical information from between sites
electronically. Aim is to improve patient care and cut costs
Nurses can monitor chronic health conditions. Medical homes are designed to offer the lion’s
share of preventative care. Aim is to improve population health and cut costs Simulation and Virtual Patients Simulating is increasingly being used in
nursing education. Mannequins are programmed to talk and have
vital signs. Nurses can practice skills without risking
making an error on a human patien.t
Lack of transfer of skills from simulation to
clinical practice has been reported. Interactive Games and Health
Promotion Internet- and computer-based health games
can help users: Evaluate health risks and their consequences
Obtain needed health education
Engage in an enjoyable activity Example: Dr. Health’nstein’s Body Fun
software (for schools) E-Health and Health Promotion Electronic health (e-health) uses cell phones,
mobile computers, text messaging, email,
Internet postings, and Internet support
Goal is to motivate patients to engage actively
in their health care
Older people are more likely to use cell
phones than the Internet. Information sent by cell phone is less secure. Electronic Self-Care Education
Materials About 50% of Americans use the Internet to
access health-related information.
The Internet includes biased, incomplete, and
Nurses can empower patients by providing
lists of reputable Internet sites.
Interactive Internet discussion boards and
support groups have become popular. Use of Technological Devices to
Promote Health Mobile electronic devices have been woven
into clothing or attached as an accessory. Monitor health and possible emergency situations Microprocessors are being placed in the caps
of medication containers.
Unobtrusive health sensors are being
developed. Such as a device worn by children that measures
ozone while recording activity data Advantages and Disadvantages of
Technology in Health Promotion Advantages More opportunities to tailor
information to needs of
individuals of groups
Improved capability to match
user learning style
User anonymity while seeking
information or support
Increased access to
information and support on
Enhanced ability for users to
update and maintain current
scientific knowledge Disadvantages Costly to develop, update,
Often rely on the user being
able to afford fast Internet
Ability to select and use
search terms is necessary
Possible information overload
Internet acceptability varies
with age, literacy level, and
gender, age, and ethnic/racial
access issues remain Nurses Nurses make up the largest group of
healthcare workers using informatics.
Informatics helps the nurse collect, record,
and retrieve patient data.
There are many benefits associated with EHRs.
New developments include telehealth,
medical homes, virtual reality, and e-health. Beginning Nurse Competencies
Computer literacy (CL) Information literacy (IL) Nursing (Overall or Health)
Informatics (NI) Each competency builds on the previous
14 Computer literacy (CL) Competencies Is a set of skills that allows individuals to use
computer technology to accomplish tasks
(ANA, 2008, p.125).
Focuses on computer basics
The use of applications such as word
processing, databases, spreadsheets, email,
and presentation software.
15 Information literacy (IL) Competencies A set of abilities allowing individuals to “recognize
when information is needed and how to locate,
evaluate, and use effectively the needed information.
(Association of Colleges and Research Libraries,
The focus is on information access and evaluation.
An example is retrieving and evaluating information
from the Internet.
This is the focus of today’s class.
16 Nursing Informatics (NI) Competencies Is defined as “combining nursing science,
information management science, and
computer science to manage and process
nursing data, information, and
knowledge to deliver quality care to the
public." (HRSA, 2008). 17 Examples of Nursing Informatics
Should include (but is not limited to)
identifying, collecting, and recording data
relevant to patient care. Using informatics applications designed for
nursing. Implementing policies related to
confidentiality and security of information.
ANA (2008) 18 Sources of Information 1. Primary – original research
reports in journals
2. Secondary – indexes the primary
literature. i.e. Medline
3. Tertiary – summarizes the
primary literature i.e. text books.
4. Gray Information – web based
19 Pros/Cons of the 3 “Traditional”
Sources of Information Pro: Primary, secondary and tertiary are
accessible to varying degrees (2° and 3° most
Pro: Secondary and tertiary information
summarizes key information thus is user friendly
in decision making.
Con: Searching primary information is time
consuming and the yield may not be directly
usable in decision making.
20 Our 4th Source: Gray Information
Cons: Not indexed; not organized Searches can be time consuming Need computer expertise Sources/information can be of varied quality May be difficult to evaluate its quality Need good hardware
Pros: Very accessible Interactive Cutting edge information
21 How is the Complex Gray Data
Web based data is organized in two main ways:
1. Web Portals- Also called a “links page”
ernational.html#internet Yahoo , AOL are web portals 2. Data warehouse- a repository of an organization's
electronically stored data. Data warehouses are
designed to facilitate reporting and analysis. Goal
is data centralization Inmon, W.H. Tech Topic: What is a Data Warehouse?
Prism Solutions. Volume 1. 1995. 22 Data Warehousing in Health Care Collection of data/databases gathered and
organized so that it can easily by analyzed,
extracted, synthesized, and otherwise be used
for the purposes of further understanding the
Databases: Usually within a data warehouse:
An application that manages, updates data for
quick and easy retrieval . It is data that is
usually related in some way.
23 Who collects health data? US government
State governments (varied levels of detail)
County or local governments (varied levels of
International governments (varied reliability)
Non Profit or NGO
Special interest groups: DM, Spina Bifida, MS,
(more common to make data sources available
to the public)
24 3 Government Data Warehouses
CDC National Center for Health
Statistics BRFSS (Behavioral Risk Factor
Surveillance System) CDC WONDER which is the
Wide-ranging Online Data for
Epidemiologic Research •
•CDC: Makes health & behavioral info available to health
professionals, researchers, academics & public • Menu driven: Composed of reported statistics, fixed
data sets/tables • You can develop tables/charts from data based on
you input & customize reports you create. 25 Practice Using CDC WONDER
Group 1 Go into WONDER
Go to Topics
Go to Leading Causes of Death
Go to 1999-2007
Find the top 3 leading causes of death in DC 26 Practice Using CDC WONDER
Group 2 Go into WONDER Topics to On Line TB Information System (under Communicable
Data Request Current TB Case Reports
Produce a chart that will tell us something about the status of TB in
DC. (bi-variable: age groups standard, select location (DC),
Alive, then most current
year SEND -then CHART Which age group has the highest rate of TB in DC?
27 Vital Statistics on the WONDER Web
Site: Group 3 Vital statistics tables
Go to Infant Deaths, go to 2007
Variable: Choose Cause of death
What is the first and second most common
causes of death in babies for the US?
What does “suppressed” mean? 28 Behavioral Risk Factor Surveillance
System : Group 4
Largest on going telephone health survey Adults
Go to Prevalence/Trends
What percent of the adult population are
current smokers in VA? In DC?
Youth Risk Behavior Surveillance System (YRBSS) .
htm 29 US Data and Maps : Group 5 What areas of the country should the US focus
most of its efforts in disease prevention and
education related to the West Nile Virus? 30 Local Statistics: Group 6 DC Dept of Health Look at the BRFSS – What percent of the DC population is
covered by health insurance compared to national data ?
What ward has the highest percent of the population
covered? Arlington Dept of Health
ealth/HumanServicesServicesHealthPublicHealth.aspx Virginia Dept of Health
31 The Challenges in Finding Maps:
Group 7 The CDC web sites are all different formats
Usually look for Data and Statistics
For example – Go to CDC Home
Go to diabetes; Go to Data and Trends
See US and State Maps.
Now try to find a map for HIV/AIDS
Others are very easy – Heart Disease and
32 Census Data: Group 8
US Census – Zipcodes
Enter a zip code ( MU= 22207) and find:
• Renters vs own house
• Age of house
• How large is house, how many bedrooms and baths
• Average income
33 Not All Data Are Created Equal
Data Collection: Are not
because are not directly
linked to disease control
activities; are useful in other
ways National Vital Statistics
records (birth and death) Disease registries Surveillance Systems: Data
analysis that is always linked
to efforts to control disease. BRFSS (Behavioral Risk
Surveillance System) (NNDSS) National Notifiable
Data Surveillance System 34 United Nations on the WWW World Health Organization - UN Affiliate - is the directing
organization for health in UN system
35 Others i.e. NGOs Kaiser Family Foundation
The Urban Institute
36 Challenges with US Data Searches Categorization/indexing non-existent
Decentralized- causes variation in how data is
Historical data “iffy”
Time intensive so real time data are not
37 Challenges with International Data Even more difficult
Limited sources of data
Often not collected due to lack of resources in
UN and WHO are the main resources 38 Data Mining
Explore data for hidden trends/patterns Analyze data from different perspectives and
summarize it into useful information Information can be used to increase revenue,
cuts costs, or both. Data mining software is one of a number of
analytical tools for analyzing data.
39 Data Mining
Example: A grocery chain used the data mining capacity of Oracle software to analyze
local buying patterns.
They discovered that when men bought diapers on Thursdays and
Saturdays, they also tended to buy beer.
Further analysis showed that these shoppers typically did their
grocery shopping on Saturdays. On Thursdays, however, they only bought a
The retailer concluded that they purchased the beer to have it
for the upcoming weekend.
To increase revenue the beer display moved closer to the diaper display.
And, they made sure beer & diapers were sold at full
price on Thursdays. Sourcehttp://
40 Chapter 4
Genetic and Social
Health: An Ecological
Perspective Objectives (1 of 2) Identify the major determinants of health.
Explain the ecological model and its
application in health promotion.
Apply the ecological model to a health
Explain the stress–diathesis model and how it
affects health outcomes. Objectives (2 of 2) Define epigenetics and its mechanisms.
Explain the significance of both genetics and
environmental factors on health.
Develop health promotion strategies using the
ecological framework. Introduction Advances in nutrition, vaccines, sanitation ,
and infant survival have improved quality of
life and increased life spans.
The complex interactions between biological
and social elements, and their influence on
health, are called the determinants of health. The Ecological Framework Determinants of health Biological
Environmental A departure from past nature-nurture
Genes and environment are intricately linked. The Stress–Diathesis Model Examines how social circumstances and
individual responses to stressful events affect
health At the cellular and physiological level One’s current health status reflects
physiological responses to past experiences.
Diseases linked to stress include depression,
ulcers, colitis, heart disease, and adult-onset
diabetes. Genetic Determinants of Health
(1 of 2) Gene regulation and mutations Gene regulation turns genes “on” or “off”—critical
to maintaining life.
Mutations can change gene regulation.
Mutations can be harmless or can cause disease. Gene–environment interaction
Occurs at cellular level Risk behaviors illustrate such interaction
Genetic Determinants of Health
(2 of 2) Epigenetic mechanisms “Epigenetics” refers to inheritance that is not
explained by changes in the DNA.
Highly influenced by the internal and external
Two main mechanisms: DNA methylation and
histone modification The Nurse’s Role Nurses need to be educated about genetics
and understand genetic influences on disease
in order to:
Convey genetic information and disease risks to
patients Effectively participate in disease management Assess patients for familial patterns of disease
Social Determinants of Health WHO definition: The circumstances in which people are born, grow
up, live, work and age, as well as the systems put
in place to deal with illness
These circumstances are in turn shaped by a wider
set of forces: economics, social policies, and
politics Health promotion strategies can result in
meaningful interventions. The Social Gradient of Health Evidence has shown that mortality increases
with decreasing socioeconomic position. Not just between low and high socioeconomic
positions, but within those levels A suggested factor is difference in social
The assumption is that there is less stress as one
goes up the social gradient.
Cultural Perspectives Understanding cultural diversity and the
complex nature of culture is the cornerstone
of health promotion.
Culture is linked to perceptions about health.
Leininger’s theory of culture care diversity and
universality gives a framework to understand
cultural dimensions. Culture and the Social Gradient In addition to cultural values of individuals and
social groups, the nurse needs to consider: Demographic factors such as income and
How these factors interact with other influences in
the ecological environment to contribute to the
determinants of health Summary Determinants of health are biological, social,
cultural, and environmental. Genes and the
environment are intricately linked.
Nurses need to be educated about genetics
and understand genetic influences on disease.
Important factors are cultural perspectives
and the social gradient. Chapter 5
Health Disparities Objectives (1 of 2) Define a health disparity.
Describe how quality of care and access to care
affect health disparities.
Discuss how health disparities are determined
Identify various health disparities that impact
Articulate which factors and policies contribute to
health disparities. Objectives (2 of 2) Discuss effective ways to intervene to decrease
Discuss the role of governmental organizations in
decreasing health disparities.
Describe why it is crucial to increase the
involvement of diverse populations in health
Evaluate policy recommendations for reducing
health disparities and identify policies that are
most likely to have substantial benefit. Introduction Not all individuals have enjoyed the same
degree of increased life span and quality of
Select populations experience a
disproportionate disease burden.
Health disparities exist based on factors such
as race, ethnic group, geographic area, gender,
age, income, education, disability, and culture. Definitions of Health Disparities A population is a health disparity population if
there is significant disparity in rates of: Disease incidence and prevalence
Morbidity and mortality
Survival Included are populations with considerable
disparity in the quality, outcomes, cost, use,
access to, or satisfaction with healthcare
services. How Disparities Are Determined Three health statistics are used. Incidence (number of new cases)
Mortality (number of deaths)
Survival rates (length of survival following
diagnosis) Types of Health Disparities Asthma, cancer,
Low birth weight, infant
Violence Quality of care
Disparities in access to,
use of, and cost of care
Language fluency and
Gender, age, and
Rural populations Factors Contributing to Health
Disparities (1 of 2) Examples of factors within the healthcare
delivery system Lack of insurance coverage
Quality of insurance
Availability of providers and facilities
Ineffective provider–patient communication
Fragmentation and lack of follow-up care
Language and cultural barriers Factors Contributing to Health
Disparities (2 of 2) Examples of factors outside the healthcare
delivery system Age, gender, education level
Socioeconomic status, race and ethnicity
Taking time off from work, childcare issues
Lack of knowledge of appropriate health care
Cultural beliefs, lack of trust of healthcare
providers and systems Interventions for Minimizing Health
Disparities Rely on the cultural expertise of members of the
target group in designing educational materials
Increase access to online services and to
screening and prevention
Tailor approaches to the needs of specific cultural
Increase diversity of the workforce
Follow culturally and linguistically appropriate
standards for health care Role of Government and Other
Entities in Decreasing Health
Disparities The government has taken the lead in
decreasing health disparities. Not researchers, professional organizations,
private foundations, or community advocates CLAs- Culturally and linguistically appropriate
The NIH identified health disparities as a
research priority in 1999. In 2000 the National Center on Minority Health
and Health Disparities was established. Research and Epidemiology Reliable data are necessary to understand and
take steps to minimize health disparities.
Having an accurate baseline from which to
gauge progress is vital.
Several methods of monitoring and evaluating
health disparities are also ways of minimizing
disparities. Future Trends and Associated
Costs Reducing disparities is necessary to: Contain healthcare costs
Provide equitable care to the entire U.S.
View Full Document