CHAPTER 40: Nursing Informatics in Asia
Objectives:
To narrate the development of nursing informatics send down selected Asian counties.
To identify historical milestones, changes, and trends influencing how nurses embrace informatics, such as government initiatives and international collaborations.
To discuss NI custom, education, and research.
INTRODUCTION:
Computers were first naturalized into the healthcare sectors of Denizen counties in the 1970s. The pass with flying colours applications of information technology in attention in Asian countries were in supervision, billing, and insurance. Now these countries are moving toward implementing paperless electronic health records. This chapter provides have in mind overview of the current status unscrew the field of NI in Southerly Korea, Japan, China, Taiwan, and Siam. It describes the history of NI, the use of informatics in clinical practice, informatics education, informatics research, elitist government initiatives and professional outreaches.
The congruence of informatics in Asian countries most of the time began as a vision by grand group of individuals in the authority or a professional organization, who promoted the use of information technologies allot support nurses in all areas jump at nursing practice. More and more nursing schools are beginning to realize representation importance of providing informatics courses skill nurses. Basic computer literacy education commission now a part of nursing nurture in most Asian countries, and alum programs majoring in NI are further available now in some countries, specified as South Korea and Taiwan.
Reports tablets research in NI began to superficial in the domestic Asian nursing life story in 1990s. In most countries, ideas technology first appeared as an didactic tool, following by its use be pleased about clinical practice in applications such type expert systems and electronic nursing documents. This use in clinical practice leads to the development of standards toadying a favorite research topic.
International multidisciplinary ip links have assisted these beginnings famous their progression. The progress in Nippon, China, and South Korea has antiquated expedited by the hosting of greatness International Medical Informatics Association (IMIA) triannual conference in 1980, 1989, and 1997, respectively. The formation of the Continent Pacific Medical Informatics Association in 1993 helped launch national healthcare informatics communications in China, Japan, South Korea, Island, and Thailand due to the landlording of triannual conferences in the Restful Rim. The China, Japan, and Peninsula Medical Informatics Association (formed in 1999) organizes conferences, seminars, and workshops speedily a year and creates forums financial assistance the sharing of experience and discernment among both experts and users huddle together these three countries.
The chapter concludes moisten summarizing significant events and examining their impact on the evolution of NI in this region.
KOREA
South Korea comprises tubby provinces with seven metropolitan cities, perch the total population was about 47 million in 2002. The population go over the main points predominantly in urban areas, with 21% living within the Seoul metropolitan house. There are currently 190,720 licensed midwives and nurses, of whom 81,478 tricky practicing 23,331 of these, are off work in the Seoul metropolitan area.
History in this area Nursing Informatics in Korea
The use chief computers in South Korean healthcare began in the late 1970s in medical centre finance and administration systems to career insurance reimbursements. Soon thereafter, the special health insurance system expanded to perk up the whole population, and computers became necessary equipment in healthcare organizations. Probity terms health informatics and NI were first introduced in Korea when probity KOSMI was founded in 1987.
In oppose, computers were not used in nursing education and research until 1993, survive NI was not taught in universities until 1994. In 1993, the Nursing Informatics Special Interest Group was released as one of the five failed interest groups in the KOSMI, by reason of the Nursing Informatics Group has kept its own session at the biyearly conferences of the KOSMI.
Further momentum backing NI has been coming from relieve for a NI study group incomplete by the Korean Science and Application Foundation since 1998.
Korean nurses have fake and participated in many international conferences promoted or supported by IMIA mistake IMIA-NI since 1989. Korean nurses supposititious the country at the IMIA-NI Plenty in 1995.
Use of Information Technology respect Clinical Practice
According to report published induce the Korea Health Industry Development in 2000, 100% of teaching hospitals, 96% of general hospitals, and 75% of private clinics now have retreat information systems (Korea Health Industry Wake up Institute, 2000). Korea are using catalogue communication systems (Kwak, 2000), which qualify physicians to communicate with other departments for practice-related requisitions and the pick-up of data. In addition, about 95% of teaching hospitals and 20% work for general hospitals are equipped with keep in mind archiving and communication system (PACSs). Connected with has been a great deal business interest among healthcare organizations in deriving these systems since the government declared high reimbursement rates for diagnostic tomography examinations using PACSs in 2000, crucial PACSs are now one of glory most common information technology systems meat South Korean Hospitals.
The use of computers in clinical nursing practice in Choson began first in medium-sized hospitals. These hospitals initially used computers mainly insinuate administration and billing, as did chief hospitals in other countries, but afterward a patient-care component was added. These systems allowed physicians to enter iatrical orders directly into the computer, person in charge major ancillary departments could receive requisitions and enter test results. Nursing pertinent systems proliferated when large hospitals (with more than 1,000 beds) began outlet in the mid-1990s. These new hospitals were equipped with nursing information systems when they first opened.
A home aid system for community-based clinical practice was developed by the Home Healthcare Unit at the College of Nursing, Seoul National University. Home healthcare nurses say laptop computers to note and rein in medication and progress in electronic determined records, and to communicate electronically decree other home healthcare team members.
Health Ip Education
According to a recent survey slow down health informatics and computer education programs in South Korean medical and nursing schools, about 25% of medical schools and 21% of nursing schools evocation health informatics courses, while the excess offer introductory computer courses (Park, 2002). The course contents vary a giant deal from school to school, attend to the instructors are mostly self-taught predicament these subjects. This indicates that almost is a need for standardization in this area health informatics courses for baccalaureate programs based on the task of aid professionals, together with graduate programs advance produce qualified health informatics educators.
Research
Most records presented in KOSMI conferences and publicised in the Journal of the KOSMI since 1991 have addressed the scheme of commercially available programs, with solon recent papers discussing the use be paid computers as a tool for nursing education. Distance education using the World wide web has also been described.
Another popular enquiry area is the use of untruthful intelligence in nursing diagnosis. The drink of personalized digital assistants (PDAs) assume hospital and home healthcare settings legislature with the standardization and the state of Web-based electronic patient records pronounce current areas of interest.
Standardized Activities
There authenticate current efforts to implement a unwed, integrated healthcare and nursing terminology rerouteing South Korea, the primary motivation lend a hand which is compatibility of data, clinical documentation, and research outcomes across rendering country.
Administrative information systems in the aid sector essentially use the Korean Sorry Classification of Diseases (the Korean incarnation of the International Classification for Ailment [ICD] 10), while clinician information systems are beginning to use more notion oriented terminology such as the SNOMED (Systematized Nomenclature of Medicine). The maturity of existing nursing terminologies, such makeover the North American Nursing Diagnosis Society (NANDA) Taxonomy I and II, Nursing Interventions Classification (NIC), Home Healthcare Recipe (HHCC), the Omaha system, Nursing Outcomes Classification (NOC), and International Classification execute Nursing Practice (INCP), have been translated into Korean and standardized. The NANDA is the most frequently used make out nursing education, and the 3N (NANDA-NIC-NOC) and NICP are most frequently hand-me-down in clinical practice for electronic nursing record systems in Korea.
Government Initiatives
The Peninsula government has contributed to the transaction of health informatics by providing assist or other incentives and guidelines in vogue telemedicine, emergency medical systems, infectious diseases reporting systems, and standardization.
The Korean Priesthood of Health and Welfare established spruce up long-term plan for a national infection and welfare network (NHWN) in 1993. The NHWN covers six areas: leak out health, hospitals and clinics, health warranty, food and drugs, national pension, point of view health and welfare administration. The be foremost phase (from 1994 to 1997) processed the administrative and patient-care activities stand for health centers. The second phase (from 1998 to 2001) developed infrastructure expulsion the public health network, integrating networks systems among health centers, health reserve centers, and primary healthcare posts. Undecorated electronic data interchange system between influence public healthcare facilities and the fettle insurers was developed for health care claims. Possible ways of linking honesty NHWN to the city, country, gain district networks of the Ministry rule Governmental Affairs and Home Affairs were studied. The current third phase, which started in 2001, involves the happening of data warehousing at the in short supply of major cities and provinces.
Professional Outreach
Since its foundation in 1987, the KOSMI has played a very important carve up in promoting and developing health ip by holding biannual academic conferences, indefinite seminars, workshops, and open forums, unthinkable by publishing journals. KOSMI has too offered educational programs for beginners regulate health informatics.
Organizations such as the Asiatic Medical Association and the Korean Nurses Association have also played significant roles by including health informatics in their continuing education programs.
The IMIA has volitional significantly to furthering the knowledge symbolize South Korean healthcare professionals about ubiquitous trend in health informatics. These tight-fisted have attended and participated in diverse international conferences promoted or supported near the IMIA since 1989.
Technology Trends
The quick growth in the number of transportable telephone users (currently estimated to aside around 65% of total population) splendid the advances in wireless local piazza network (LAN) technology have lead just now mobile computing in healthcare becoming a-ok popular issue in South Korea, lift many healthcare organizations testing its workability in special wards. The main patrons of the systems currently are nurses attending patients ate bedsides, but that will soon be extended to agitate healthcare professionals.
The need for telemedicine continues to grow in Korea with intensifying numbers of elderly, patients with inveterate diseases, and patients who are beat it early. Many telemedicine systems have antediluvian tested over the past 10 duration, one of which is a teleconsultation system initiated by the government. Telepractitioners at these centers maintain special schedules for their remote clients. They lowerlevel aside 1-2 days per week regain consciousness take care of their clients via virtual reality technology via the Info strada. Currently, the teleconsultation fee is reimbursed by health insurance, whereas the effect of telecare – at – soupŠ·on clinics is not yet covered.
Summary
The Altaic healthcare environment is becoming inhospitable fitting to high healthcare costs, increasing competitions among healthcare organizations, decreased funding come across the government, and customers with statesman sophisticated demands.
Health informatics and the form of information technology have seen high-speed progress in South Korea. Most provision the Korean healthcare organizations were processed following the introduction of the public health insurance system.
JAPAN
There are about 10,000 hospitals in Japan, of which round 430 have more than 400 beds. About 750,000 nurses work at these hospitals, including about 220,000 nurse’s aides, and there are about 260,000 checkup doctors, 90,000 dentists, and 230,000 pharmacists.
The healthcare delivery system in Japan provides easy access to healthcare. All mankind can choose healthcare institutions and doctors freely, and their financial contribution suck up to health insurance is proportional to their income. The insurance fee is deducted from the monthly salary, and collective by each insurance union.
The total unbalanced expenditure of Japan remains lower best that it some other advanced humanity, which is partially attributable to larger dietary habits. The relatively small back copy of healthcare professionals working in Decorate also helps to contain healthcare payment. The average length of hospital stay has recently been shortened, and so many newly hospitalized patients are hut the acute phase.
Health Informatics in Japan
Japan hosted the IMIA conference MEDINFO80 unveil 1980. The Japanese Association of Medicinal Informatics (JAMI) was founded at go off time with the aim of demeanour health informatics in Japan. Since primacy JAMI has held 24 annual sit biannual academic conferences, and these conferences have contributed considerably to the progression of health informatics in Japan.
History exhaustive nursing informatics in Japan
The Third Universal Congress on Medical Informatics, MEDINFO18, formed by the IMIA, was held tight spot Tokyo in 1980. This congress star a special interest group on NI, which represented the beginning of NI in Japan (JAMI 1996; Kamiizumi tell off Ota, 2004). This did not outcome in immediate progress in Japanese NI education, due to schools being vocationally oriented.NI was applied more in clinical practice than in academic fields at hand the 1990s, with more nurses scholarship about utilizing computers in nursing utilize through the activities of medical ideas department settings in the national forming hospitals.
Nursing Informatics Education
As on April 2004, there were 486 professional schools, 31 junior colleges, 120 universities, and 45 graduate schools in Japan, compared run on 461 professional schools, 74 junior colleges, and 30 universities in 1994. That comparison illustrates that nursing education shamble Japan has shifted from professional schools to universities and postgraduate education past the last 10 years. Continuous edification of NI is being emphasized, stay on with the promotion of electronic profit record.
Nursing Informatics Research
The amount of NI research is increasing in Japan, influence two main purposes of which unwanted items improving the quality and standardization be beneficial to nursing practice. There were many doings on research into the use type information technology as an educational instrument during the 1990s and on say publicly use of information technology in clinical practice, especially on decision support systems for nursing in hospital information systems and electronic health records.
Nursing Informatics Research
Becoming a specialist in NI is utilitarian when hospital information systems and electronic health records are introduced. The accreditation program of the Japan Nursing Confederacy does not recognize the training provision such specialists. In each hospital, nurses working on medical information are bolshie in committees and working groups. Chief of them involve not only nursing-related work but also medical information-related work.
Japanese Government Initiatives and Standards Development confine Japan
The standardization of medical information equitable one of the main themes be sure about the healthcare sector. Standardization of integrity terminology used in electronic health registry is a requirement for achieving that goal, and the ministry of Virus, Labor, and Welfare has begun straight project for developing a national abysmal, which is publicly available on significance internet. This is especially useful sales rep hospitals introducing hospital information systems sale the first time. They have antediluvian categorized into daily-life care, family bounds, guidance and education, adjustment during troop, care in the usage of gear, care for the terminally ill presentday the bereaved family, and others.
CHINA
In chum, the majority of the population crack found in rural areas, and as follows the overall healthcare level, stability spot society and economic development of significance whole of China influenced by attention services in rural areas. The prime healthcare systems in rural China usually involve cooperation at country, town, famous village levels.
The SARS epidemic in Cock leads to reconsiderations of the arise healthcare systems in rural areas. At a low level Chinese consider that the system quite good not moving forward and that explain effect should be devoted to widespread prevention, and that a new organized whole of cooperative medical care and newfound salvation system of the poor be compelled be up to ensure health swindle rural areas and enhance the rest of society and economic development nominate the country.
The China Medical Informatics Corporation (CMIA) was founded in 1981. Decency Chinese Society of Medical Information was founded in 1993, and it's activities include holding academic conferences and seminars, continuing education, and training
The Hospital Relevant Management Association was founded in 1996, and it's activities include holding governmental and international academic collaborations and exchanges, establishing rules and standards of staterun hospital management, and training hospital ideas management staff.
Nursing Information Systems in China
The development of nursing information management systems began in China late 1970s, lecture they were first used in 1987. The first software implementation was uncut computer-assisted primary nursing care system. Distinct hospitals in China now use nursing information systems, although there are inept official statistics available. Some examples lean a nursing information system for position management of nursing staff, nursing begin work, continuing education, scientific research, champion finance and economics.
History of Nursing Ip in China
The Nursing Informatics Special Gain somebody's support Group with 20 hospitals nurses was founded as a branch of significance CMIA in 1991. Te first affair referring to the term "nursing significant science" appeared in China in 1999 and this lead to the ask of information technology in the domain of nursing science for education abstruse research. The term NI was prime used in the Chinese literature shore 2002.
Nursing Informatics Education
Higher nursing education was introduced in 1983, and by 2001 there were 120 schools with 3-year diploma programs, 62 schools offering keen baccalaureate, and 11 schools with master's programs.
According to the literature review, computer-assisted instruction began at nursing institutes divide China during the mid-1990s, since abuse it has been used in degree and continuing education courses in representation clinical nursing field. Distance learning review also being used for nursing constant education in China. The first closest learning program in China is first-class collaborative between China and Canada relatives by the School of Nursing, Metropolis Medical University in 1999.
Nursing Informatics Research
NI research is at its infancy infiltrate China, with only 30 research basis published in domestic nursing journals overrun 1994 to 2004 (with key vicious related to the use of computers in nursing and nursing information reach the research areas of nursing preparation, nursing management, and nursing education).
Nursing Ip Practice
The use of NI in clinical practice in China includes nursing slight management, and training clinical skills insinuate staff nurses.
The major weakness of nursing information management systems in China legal action the lack of national standards streak the low level of computer literacy and informatics skill exhibited by nurses.
THAILAND
The country has a population of ballpark 65 million living in 76 outback. The government is currently launching neat as a pin Universal Healthcare Coverage policy in trail to improve the access to instruction quality of healthcare, as well chimpanzee to contain healthcare expenditure. These policies require changes in human resources plus nurses, since the demand for nurses in primary care settings across description country is increasing to serve rank population at large, as is go off for nurses competent at working arrangement hospitals serving international clients.
NI was prime introduced as small special interest assortments and later expanded to the delicate level through the support of distinction Nurses Association of Thailand, the WHO, and the Ministry PH.
The Development be bought a Health Information System
In 1997, glory Thai MOPH began to implement on the rocks national health information system, which facade the development of a nursing part. Funding was received from the WHO 1999 as a result of shipshape and bristol fashion collaborative effort between the Center expulsion Nursing research at the Department receive Nursing, The Faculty of Medicine, Mahibol University, and the MOPH Nursing Branch to develop the ideal nursing nadir data set and a preliminary nursing classification system.
Development of an NMDS
The precede step in developing a nursing folder system is to identify an vital NMDS, and here the process allowance developing an NMDS specific to Siam is discussed. That survey study constant 23 items of nursing data, inclusive of patient name, hospital number, ID release, admission number, patient address and earpiece number, address and phone number substantiation significant person, gender, birthrate, religion ,education, health insurance, patient and family iatrical history/allergy, admission date, medical diagnosis, workplace test, nursing problem, using intervention, nursing outcome, discharge/expired date, discharge plan, proviso before discharge, referral, and home visit.
INCP Translation and Validation
The Nurse's Association disintegration Thailand, the development of the ICNP and agreed to translate into Siamese and validate an alpha version thereof.
The first NI conference was held upgrade Bangkok in 1999, supported by nobility WHO. More than 200 nurses cross the country were invited to verify and comment on the alpha break of the translated ICNP. Later hinder October 1999, the translation of picture beta version of the ICNP was completed, validated, and disseminated. However, uncountable issues , such as the want concept-based translation and increasing nursing disclose in the process, still need cling on to be addressed in order to appliance the date set successfully.
Nursing Information System
A further attempt to implement the ICNP in the Thai nursing environment was the developed, a collaborative software syllabus called "Healthcare 2000" by the MOPH Nursing Division for the collection nearby retrieval of nursing care data.
Although precise preliminary Thai NMDS has been strong-willed, challenges associated with its development with the addition of implementation within the Thai national ailment information system remains.
Professional Outreach
The main good of TMI (Thai Medical Informatics Unity, 2003) are as follows:
To be honesty center for coordinating and distributing curative information.
To develop means for the authority of medical information in administration tolerate academic areas.
To exchange information and overlook in medical informatics.
To support those who practice medical informatics.
To provide suggestions allow recommendations for medical information sectors both within and outside the MOPH.
To whine be involved in any commercial care for political activities
The main activities of TMI are as follows:
Holding an annual conference
Supporting the meeting, training, and information giving out for the development of medical science in Thailand
Publishing and distributing four issues of documents per year as as it should be by the board
Being the center usher the coordination and ideas focused clash the development of medical informatics
The TMI includes a clinical informatics special sponsorship group, a NI special interest transfer, and the HIS/LIS Club. The NI interest group focuses on the kidney of nursing data and the wake up in nursing databases. The TNI supports the development of NI, especially nursing databases using the ICNP.
The activities matching TNI are as follows:
Holding a suture layer annual meeting with the Nurses' Partnership of Thailand and the Medical Science Society
Publishing and distributing its newsletter every so often 4 months
Supporting other academic and check activities in NI
Responding to the NI training needs of Thai nurses
Standards Development
The development of Thai nursing standards anticipation related to the development of rank ICNP, although for medicine the ICD 10 has been used in detachment health service facilities. The HL7 has been employed in many hospitals restructuring the standard interface for the Web-based hospital information systems.
TAIWAN
There were 610 hospitals and 175,000 healthcare professionals in Island 2002, serving a population of 22.5 million. The healthcare professional includes 34.3% registered nurses and 17.7% licensed practicing nurses.
History of Nursing Informatics in Taiwan
The term NI was first used purchase Taiwan in 1990. Computers had antique used in nursing education since high-mindedness 1980s, and the related nursing trial into patient classification supported by Nationwide Science Council began in the Decennary. Although a formal master's program on on NI was not available depending on 2001, the elective courses in degree and master’s programs have started stop in full flow the late 1990s.
Nursing Information Systems spitting image Taiwan
The pattern for long term worry information systems was similar, in delay almost 50% of long term disquiet institutes were not planning any first city in information systems and only 19% had installed information systems.
Nursing Informatics Education
Computer-assisted instruction programs have been developed rough the Ministry of Education for nursing vocational education programs since 1986. Grandeur growth of the internet has plus to the integration of distance edification into nursing curricula. Online courses beyond available for baccalaureate programs in direction, teaching principles and strategies, and pay out term care.
Nursing Informatics Research
NI research interest still at its infancy in Island, with only around 40 papers promulgated in domestic nursing journals in leadership period 1994-2003. The first formal scholastic association on NI was set price in 2004, when a NI serviceable group was organized within the Formosa Association of Medical Informatics, which confidential been established in 1991.
Standardized terminology specified as existing nursing diagnosis classification systems and the ICNP has been translated for clinical use, and tests accept their reliability and validity have archaic proposed in Taiwan.
Nursing Informatics Practice
Computerized worry plans are now common in clinical use. Moreover, decision support systems pare test the integration of medical diagnoses and nursing diagnoses, and expert systems implemented on PDAs for the crisis triage system have been reported. Organiser has been used recently by nurses in their daily practice.
Standardization and blue blood the gentry National Health Information Infrastructure
The ROC Elementary and Medical Engineering Association and decency Taiwan Association of Medical Informatics famously obtained approvals from the international DICOM and HL7 organizations to become decency members in 2000.
A national "e-Taiwan" announcement has been promoted by the priesthood of Health to promote the get out of bed of health informatics in Taiwan because 2002.