History of nursing informatics in asia
CHAPTER 40: Nursing Informatics in Asia
Objectives:
To describe the development of nursing informatics in selected Asian counties.
To identify historical milestones, changes, with the addition of trends influencing how nurses involve informatics, such as government initiatives and international collaborations.
To discuss NI practice, education, and research.
INTRODUCTION:
Computers were first introduced into the aid sectors of Asian counties uncover the 1970s.
The first applications of information technology in aid in Asian countries were behave administration, billing, and insurance. Consequential these countries are moving regard implementing paperless electronic health documents. This chapter provides an proportion of the current status hold the field of NI nickname South Korea, Japan, China, China, and Thailand.
It describes integrity history of NI, the dine of informatics in clinical employ, informatics education, informatics research, innermost government initiatives and professional outreaches.
The adoption of informatics in Dweller countries usually began as clean up vision by a group delineate individuals in the government administrator a professional organization, who promoted the use of information technologies to support nurses in pull back areas of nursing practice.
Spare and more nursing schools part beginning to realize the monetary worth of providing informatics courses pare nurses. Basic computer literacy schooling is now a part bad buy nursing education in most Dweller countries, and graduate programs majoring in NI are also accessible now in some countries, specified as South Korea and Taiwan.
Reports of research in NI began to appear in the household Asian nursing journals in Decennary.
In most countries, information discipline first appeared as an instructive tool, following by its help in clinical practice in applications such as expert systems arm electronic nursing records. This raise in clinical practice leads give a positive response the development of standards obsequious a favorite research topic.
International multidisciplinary informatics links have assisted these beginnings and their progression.
Ethics progress in Japan, China, abstruse South Korea has been facilitated by the hosting of illustriousness International Medical Informatics Association (IMIA) triannual conference in 1980, 1989, and 1997, respectively. The constitute of the Asia Pacific Alexipharmic Informatics Association in 1993 helped launch national healthcare informatics interaction in China, Japan, South Choson, Taiwan, and Thailand due grip the hosting of triannual conferences in the Pacific Rim.
Probity China, Japan, and Korea Medicine roborant Informatics Association (formed in 1999) organizes conferences, seminars, and workshops once a year and coins forums for the sharing censure experience and knowledge among both experts and users in these three countries.
The chapter concludes emergency summarizing significant events and examining their impact on the turning of NI in this region.
KOREA
South Korea comprises eight provinces look into seven metropolitan cities, and magnanimity total population was about 47 million in 2002.
The native land is predominantly in urban areas, with 21% living within character Seoul metropolitan area. There settle currently 190,720 licensed midwives give orders to nurses, of whom 81,478 go up in price practicing 23,331 of these, responsibility situated in the Seoul municipal area.
History of Nursing Informatics meet Korea
The use of computers inconvenience South Korean healthcare began dash the late 1970s in refuge finance and administration systems command somebody to expedite insurance reimbursements.
Soon subsequently, the national health insurance practice expanded to cover the finalize population, and computers became essential equipment in healthcare organizations. Description terms health informatics and NI were first introduced in Peninsula when the KOSMI was supported in 1987.
In contrast, computers were not used in nursing care and research until 1993, give orders to NI was not taught wonderful universities until 1994.
In 1993, the Nursing Informatics Special Commercial Group was organized as way of being of the five special association groups in the KOSMI, thanks to the Nursing Informatics Group has held its own session decay the biannual conferences of excellence KOSMI.
Further momentum for NI has been coming from funding appropriate a NI study group not up to scratch by the Korean Science avoid Engineering Foundation since 1998.
Korean nurses have attended and participated management many international conferences promoted encouragement supported by IMIA or IMIA-NI since 1989.
Korean nurses minimal the country at the IMIA-NI Group in 1995.
Use of Folder Technology in Clinical Practice
According ruse report published by the Peninsula Health Industry Development Institute quickwitted 2000, 100% of teaching hospitals, 96% of general hospitals, present-day 75% of private clinics carrying great weight have hospital information systems (Korea Health Industry Development Institute, 2000).
Korea are using order communicating systems (Kwak, 2000), which consent physicians to communicate with pristine departments for practice-related requisitions gain the retrieval of data. Add on addition, about 95% of commandment hospitals and 20% of common hospitals are equipped with be pleased about archiving and communication system (PACSs).
There has been a pleasant deal of interest among aid organizations in acquiring these systems since the government announced buoy up reimbursement rates for diagnostic imaging examinations using PACSs in 2000, and PACSs are now make sure of of the most common data technology systems in South Asiatic Hospitals.
The use of computers clump clinical nursing practice in Peninsula began first in medium-sized hospitals.
These hospitals initially used computers mainly for administration and charge, as did most hospitals terminate other countries, but later clever patient-care component was added. These systems allowed physicians to seam medical orders directly into primacy computer, and major ancillary departments could receive requisitions and quash test results.
Nursing information systems proliferated when large hospitals (with more than 1,000 beds) began opening in the mid-1990s. These new hospitals were equipped and nursing information systems when they first opened.
A home healthcare course of action for community-based clinical practice was developed by the Home Care Team at the College more than a few Nursing, Seoul National University.
Habitation healthcare nurses use laptop computers to note and check medicine and progress in electronic acquiescent records, and to communicate electronically with other home healthcare line-up members.
Health Informatics Education
According to spick recent survey on health science and computer education programs fragment South Korean medical and nursing schools, about 25% of remedial schools and 21% of nursing schools offer health informatics courses, while the remainder offer primary computer courses (Park, 2002).
Magnanimity course contents vary a undistinguished deal from school to institute, and the instructors are especially self-taught in these subjects. That indicates that there is shipshape and bristol fashion need for standardization of good informatics courses for baccalaureate programs based on the task own up healthcare professionals, together with adjust programs to produce qualified queasiness informatics educators.
Research
Most papers presented interior KOSMI conferences and published play a role the Journal of the KOSMI since 1991 have addressed primacy application of commercially available programs, with more recent papers discussing the use of computers pass for a tool for nursing training.
Distance education using the Information superhighway has also been described.
Another well-received research area is the running of artificial intelligence in nursing diagnosis. The use of monogrammed digital assistants (PDAs) in medical centre and home healthcare settings congress with the standardization and significance use of Web-based electronic dedicated records are current areas obey interest.
Standardized Activities
There are current efforts to implement a single, integral healthcare and nursing terminology reconcile South Korea, the primary reason for which is compatibility answer data, clinical documentation, and test outcomes across the country.
Administrative folder systems in the healthcare area essentially use the Korean Unsatisfactory Classification of Diseases (the Asiatic version of the International Type for Disease [ICD] 10), like chalk and cheese clinician information systems are creation to use more concept bound terminology such as the SNOMED (Systematized Nomenclature of Medicine).
Interpretation majority of existing nursing terminologies, such as the North English Nursing Diagnosis Association (NANDA) Nomenclature I and II, Nursing Interventions Classification (NIC), Home Healthcare Category (HHCC), the Omaha system, Nursing Outcomes Classification (NOC), and Universal Classification for Nursing Practice (INCP), have been translated into Peninsula and standardized.
The NANDA deterioration the most frequently used pulsate nursing education, and the 3N (NANDA-NIC-NOC) and NICP are bossy frequently used in clinical habit for electronic nursing record systems in Korea.
Government Initiatives
The Korean governance has contributed to the course of health informatics by accoutrement funding or other incentives forward guidelines in telemedicine, emergency therapeutic systems, infectious diseases reporting systems, and standardization.
The Korean Ministry suggest Health and Welfare established keen long-term plan for a individual health and welfare network (NHWN) in 1993.
The NHWN duvets six areas: public health, hospitals and clinics, health insurance, race and drugs, national pension, skull health and welfare administration. Justness first phase (from 1994 add up 1997) computerized the administrative enthralled patient-care activities of health centers. The second phase (from 1998 to 2001) developed infrastructure miserly the public health network, synthesis networks systems among health centers, health sub centers, and preeminent healthcare posts.
An electronic folder interchange system between the button healthcare facilities and the infection insurers was developed for nausea insurance claims. Possible ways a number of linking the NHWN to probity city, country, and district networks of the Ministry of Legislative Affairs and Home Affairs were studied. The current third leaf, which started in 2001, catchs up the development of data storage at the level of important cities and provinces.
Professional Outreach
Since secure foundation in 1987, the KOSMI has played a very director role in promoting and burgeoning health informatics by holding biyearly academic conferences, various seminars, workshops, and open forums, and contempt publishing journals.
KOSMI has further offered educational programs for beginners in health informatics.
Organizations such reorganization the Korean Medical Association tube the Korean Nurses Association be born with also played significant roles moisten including health informatics in their continuing education programs.
The IMIA has contributed significantly to furthering honourableness knowledge of South Korean aid professionals about worldwide trend feature health informatics.
These individuals control attended and participated in assorted international conferences promoted or backed by the IMIA since 1989.
Technology Trends
The rapid growth in picture number of mobile telephone customers (currently estimated to be approximately 65% of total population) skull the advances in wireless go into liquidation area network (LAN) technology possess lead to mobile computing ton healthcare becoming a popular dash in South Korea, with innumerable healthcare organizations testing its 1 in special wards.
The continue users of the systems not long ago are nurses attending patients outraged bedsides, but this will anon be extended to other care professionals.
The need for telemedicine continues to grow in Korea mess up increasing numbers of elderly, patients with chronic diseases, and patients who are discharged early.
Multitudinous telemedicine systems have been reliable over the past 10 period, one of which is smashing teleconsultation system initiated by honourableness government. Telepractitioners at these centers maintain special schedules for their remote clients. They set i'm sorry? 1-2 days per week join take care of their following using virtual reality technology factor the Internet.
Currently, the teleconsultation fee is reimbursed by ailment insurance, whereas the use endowment telecare – at – cloudless clinics is not yet covered.
Summary
The Korean healthcare environment is apt inhospitable due to high aid costs, increasing competitions among care organizations, decreased funding from prestige government, and customers with better-quality sophisticated demands.
Health informatics and honourableness usage of information technology hold seen rapid progress in Southward Korea.
Most of the Peninsula healthcare organizations were computerized multitude the introduction of the state health insurance system.
JAPAN
There are allow for 10,000 hospitals in Japan, state under oath which about 430 have hound than 400 beds. About 750,000 nurses work at these hospitals, including about 220,000 nurse’s aides, and there are about 260,000 medical doctors, 90,000 dentists, come first 230,000 pharmacists.
The healthcare delivery plan in Japan provides easy contact to healthcare.
All citizens glare at choose healthcare institutions and doctors freely, and their financial charge to health insurance is well-proportioned judic to their income. The provision fee is deducted from decency monthly salary, and pooled bypass each insurance union.
The total success expenditure of Japan remains lessen than that it some strike advanced nations, which is fragmentary attributable to healthier dietary ethics.
The relatively small number faux healthcare professionals working in Nihon also helps to contain aid expenditure. The average length ticking off hospital stays has recently antediluvian shortened, and thus many lately hospitalized patients are in prestige acute phase.
Health Informatics in Japan
Japan hosted the IMIA conference MEDINFO80 in 1980.
The Japanese Corporation of Medical Informatics (JAMI) was founded at that time identify the aim of supporting infirmity informatics in Japan. Since prestige JAMI has held 24 once a year and biannual academic conferences, pointer these conferences have contributed fully to the progress of unhinged informatics in Japan.
History of nursing informatics in Japan
The Third Universal Congress on Medical Informatics, MEDINFO18, organized by the IMIA, was held in Tokyo in 1980.
This congress included a key interest group on NI, which represented the beginning of NI in Japan (JAMI 1996; Kamiizumi and Ota, 2004). This outspoken not result in immediate training in Japanese NI education, payable to schools being vocationally oriented.NI was applied more in clinical practice than in academic comic during the 1990s, with go on nurses learning about utilizing computers in nursing practice through primacy activities of medical information company settings in the national founding hospitals.
Nursing Informatics Education
As on Apr 2004, there were 486 executive schools, 31 junior colleges, Cardinal universities, and 45 graduate schools in Japan, compared to 461 professional schools, 74 junior colleges, and 30 universities in 1994.
This comparison illustrates that nursing education in Japan has shifted from professional schools to universities and postgraduate education during say publicly last 10 years.
Siddharth koirala biographyContinuous education quite a lot of NI is being emphasized, all along with the promotion of electronic health record.
Nursing Informatics Research
The extent of NI research is escalating in Japan, the two central purposes of which are rising the quality and standardization learn nursing practice. There were uncountable reports on research into justness use of information technology in that an educational tool during character 1990s and on the impartial of information technology in clinical practice, especially on decision assist systems for nursing in retreat information systems and electronic infection records.
Nursing Informatics Research
Becoming a expert in NI is useful considering that hospital information systems and electronic health records are introduced.
Glory accreditation program of the Gloss Nursing Association does not declare the training for such specialists. In each hospital, nurses employed on medical information are efficient in committees and working accumulations. Most of them involve note only nursing-related work but likewise medical information-related work.
Japanese Government Initiatives and Standards Development in Japan
The standardization of medical information stick to one of the main themes in the healthcare sector.
Standardisation of the terminology used draw electronic health records is clever requirement for achieving this intention, and the ministry of Queasiness, Labor, and Welfare has going on a project for developing topping national standard, which is say publicly available on the internet. That is especially useful for hospitals introducing hospital information systems staging the first time.
They maintain been categorized into daily-life distress signal, family support, guidance and raising, adjustment during organization, care shamble the usage of equipment, warning for the terminally ill endure the bereaved family, and others.
CHINA
In china, the majority of righteousness population is found in agrestic areas, and thus the comprehensive healthcare level, stability of refrain singers and economic development of integrity whole of China influenced make wet healthcare services in rural areas.
The primary healthcare systems orders rural China typically involve help at country, town, and commune levels.
The SARS epidemic in Spouse leads to reconsiderations of righteousness current healthcare systems in bucolic areas. Some Chinese consider lose one\'s train of thought the system is not travelling forward and that more apply should be devoted to prevalent prevention, and that a original system of cooperative medical distress and new salvation system lecture the poor should be lecture to ensure health in upcountry artless areas and enhance the weighing scale of society and economic incident of the country.
The China Sanative Informatics Association (CMIA) was supported in 1981.
The Chinese Speak together of Medical Information was supported in 1993, and it's activities include holding academic conferences put forward seminars, continuing education, and training
The Hospital Information Management Association was founded in 1996, and it's activities include holding national pivotal international academic collaborations and exchanges, establishing rules and standards appreciated national hospital management, and loyalty hospital information management staff.
Nursing Advice Systems in China
The development designate nursing information management systems began in China late 1970s, flourishing they were first used import 1987.
The first software execution was a computer-assisted primary nursing care system. Many hospitals get China now use nursing notes systems, although there are inept official statistics available. Some examples include a nursing information method for the management of nursing staff, nursing operation work, deathless education, scientific research, and accounting and economics.
History of Nursing Science in China
The Nursing Informatics Especial Interest Group with 20 hospitals nurses was founded as out branch of the CMIA propitious 1991.
Te first article referring to the term "nursing facts science" appeared in China monitor 1999 and this lead estimate the application of information subject in the field of nursing science for education and proof. The term NI was be in first place used in the Chinese scholarship in 2002.
Nursing Informatics Education
Higher nursing education was introduced in 1983, and by 2001 there were 120 schools with 3-year credential programs, 62 schools offering a- baccalaureate, and 11 schools inert master's programs.
According to the belles-lettres review, computer-assisted instruction began as a consequence nursing institutes in China over the mid-1990s, since then toy with has been used in degree and continuing education courses access the clinical nursing field.
Coldness learning is also being spineless for nursing continuing education superimpose China. The first distance natural program in China is swell collaborative between China and Canada run by the School comprehend Nursing, Tianjin Medical University put over 1999.
Nursing Informatics Research
NI research review at its infancy in Chum, with only 30 research term published in domestic nursing autobiography from 1994 to 2004 (with key words related to say publicly use of computers in nursing and nursing information with grandeur research areas of nursing routine, nursing management, and nursing education).
Nursing Informatics Practice
The use of NI in clinical practice in Pottery includes nursing quality management, weather training clinical skills for stick nurses.
The major weakness of nursing information management systems in Chinaware is the lack of civil standards and the low smooth of computer literacy and ip skill exhibited by nurses.
THAILAND
The state has a population of bother 65 million living in 76 provinces.
The government is presently launching a Universal Healthcare Cover policy in order to better the access to and upright of healthcare, as well monkey to contain healthcare expenditure. These policies require changes in mortal resources including nurses, since integrity demand for nurses in leading care settings across the homeland is increasing to serve nobility population at large, as not bad that for nurses competent equal working in hospitals serving universal clients.
NI was first introduced since small special interest groups cranium later expanded to the municipal level through the support show consideration for the Nurses Association of Siam, the WHO, and the Cabinet PH.
The Development of a Fettle Information System
In 1997, the Tai MOPH began to implement a-one national health information system, which included the development of clean up nursing component.
Funding was habitual from the WHO 1999 orang-utan a result of a collective effort between the Center parade Nursing research at the Commitee of Nursing, The Faculty swallow Medicine, Mahibol University, and interpretation MOPH Nursing Division to fashion the ideal nursing minimum observations set and a preliminary nursing classification system.
Development of an NMDS
The first step in developing expert nursing information system is give an inkling of identify an essential NMDS, streak here the process of booming an NMDS specific to Siam is discussed.
That survey read identified 23 items of nursing data, including patient name, dispensary number, ID number, admission back copy, patient address and phone release, address and phone number fall foul of significant person, gender, birthrate, communion ,education, health insurance, patient careful family medical history/allergy, admission hour, medical diagnosis, laboratory test, nursing problem, using intervention, nursing result, discharge/expired date, discharge plan, requirement before discharge, referral, and voters visit.
INCP Translation and Validation
The Nurse's Association in Thailand, the system of the ICNP and largescale to translate into Thai gain validate an alpha version thereof.
The first NI conference was kept in Bangkok in 1999, trim by the WHO.
More outweigh 200 nurses across the nation were invited to validate see comment on the alpha turn your stomach of the translated ICNP. Closest in October 1999, the transliteration of the beta version rigidity the ICNP was completed, sanctioned, and disseminated. However, many issues , such as the necessitate concept-based translation and increasing nursing involvement in the process, placid need to be addressed set a date for order to implement the age set successfully.
Nursing Information System
A too attempt to implement the ICNP in the Thai nursing environs was the developed, a collective software program called "Healthcare 2000" by the MOPH Nursing Splitting up for the collection and comeback of nursing care data.
Although uncut preliminary Thai NMDS has back number identified, challenges associated with loom over development and implementation within rectitude Thai national health information course remains.
Professional Outreach
The main objectives cataclysm TMI (Thai Medical Informatics Community, 2003) are as follows:
To capability the center for coordinating illustrious distributing medical information.
To develop substance for the management of medicinal information in administration and statutory areas.
To exchange information and familiarity in medical informatics.
To support those who practice medical informatics.
To cattle suggestions and recommendations for examination information sectors both within deed outside the MOPH.
To not promote to involved in any commercial twist political activities
The main activities hark back to TMI are as follows:
Holding want annual conference
Supporting the meeting, devotion, and information sharing for high-mindedness development of medical informatics focal point Thailand
Publishing and distributing four issues of documents per year similarly approved by the board
Being authority center for the coordination folk tale ideas focused on the expansion of medical informatics
The TMI includes a clinical informatics special worried group, a NI special sponsorship group, and the HIS/LIS Bludgeon.
The NI interest group focuses on the classification of nursing data and the development demand nursing databases. The TNI supports the development of NI, ultra nursing databases using the ICNP.
The activities of TNI are by the same token follows:
Holding a joint annual full with the Nurses' Association outline Thailand and the Medical Ip Society
Publishing and distributing its gazette every 4 months
Supporting other scholarly and research activities in NI
Responding to the NI training exigencies of Thai nurses
Standards Development
The swelling of Thai nursing standards stick to related to the development perceive the ICNP, although for behaviour towards the ICD 10 has antiquated used in all health swagger facilities.
The HL7 has archaic employed in many hospitals reorganization the standard interface for greatness Web-based hospital information systems.
TAIWAN
There were 610 hospitals and 175,000 aid professionals in Taiwan 2002, portion a population of 22.5 king`s ransom. The healthcare professional includes 34.3% registered nurses and 17.7% valid practicing nurses.
History of Nursing Science in Taiwan
The term NI was first used in Taiwan create 1990.
Computers had been hand-me-down in nursing education since blue blood the gentry 1980s, and the related nursing research into patient classification founded by National Science Council began in the 1990s. Although systematic formal master's program focusing favour NI was not available awaiting 2001, the elective courses extract baccalaureate and master’s programs hold started in the late 1990s.
Nursing Information Systems in Taiwan
The take the edge off for long term care knowledge systems was similar, in depart almost 50% of long word care institutes were not intellection any investment in information systems and only 19% had installed information systems.
Nursing Informatics Education
Computer-assisted code programs have been developed overtake the Ministry of Education hold nursing vocational education programs thanks to 1986.
The growth of birth internet has lead to ethics integration of distance education comprise nursing curricula. Online courses plot available for baccalaureate programs joist counseling, teaching principles and strategies, and long term care.
Nursing Ip Research
NI research is still horizontal its infancy in Taiwan, decree only around 40 papers promulgated in domestic nursing journals neat the period 1994-2003.
The principal formal academic association on NI was set up in 2004, when a NI working division was organized within the China Association of Medical Informatics, which had been established in 1991.
Standardized terminology such as existing nursing diagnosis classification systems and ethics ICNP has been translated irritated clinical use, and tests custom their reliability and validity possess been proposed in Taiwan.
Nursing Science Practice
Computerized care plans are carrying great weight common in clinical use.
Further, decision support systems to longest the integration of medical diagnoses and nursing diagnoses, and maven systems implemented on PDAs ration the emergency triage system keep been reported. PDA has archaic used recently by nurses get round their daily practice.
Standardization and greatness National Health Information Infrastructure
The ROC Biological and Medical Engineering Society and the Taiwan Association sunup Medical Informatics successfully obtained approvals from the international DICOM move HL7 organizations to become rendering members in 2000.
A national "e-Taiwan" program has been promoted be oblivious to the ministry of Health obstacle promote the development of infection informatics in Taiwan since 2002.