LEARN MORE ABOUT MEDICAL CODING

Medical coding is a little bit like translation. Coders take medical reports from doctors, which
may include a patients condition, the doctors diagnosis, a prescription, and whatever
procedures the doctor or healthcare provider performed on the patient, and turn that into a set
of codes, which make up a crucial part of the medical claim.

WHY WE CODE
Lets start with a simple question about medical coding: Why do we code medical reports?
Wouldnt it be enough to list the symptoms, diagnoses, and procedures, send them to an
insurance company, and wait to hear which services will be reimbursed?

To answer that, we have to look at the massive amount of data that every patient visit entails. If
you go into the doctor with a sore throat, and present the doctor with symptoms like a fever,
sore throat, and enlarged lymph nodes, these will be recorded, along with the procedures the
doctor performs and the medicine the doctor prescribes.

In a straightforward case like this, the doctor will only officially report his diagnosis, but that
still means the portion of that report that will be coded contains a diagnosis, a procedure, and a
prescription.

Take a step back, and this is suddenly a lot of very specific information. And thats just for a
relatively simple doctors visit. What happens when a patient comes into the doctor with a
complicated injury or sickness, like an ocular impairment related to their Type-2 diabetes? As
injuries, conditions, and illnesses get more complex, the amount of data that needs to be
conveyed to insurance companies increases significantly.

According to the Centers for Disease Control (CDC), there were over 1.2 billion patient visits
in the past year. Thats a stat that includes visits to physician offices, hospital outpatient
facilities and emergency rooms. If there were just five pieces of coded information per visit,
which is an almost unrealistically low estimate, thatd be 6 billion individual pieces of
information that needs to be transferred every year. In a system loaded with data, medical
coding allows for the efficient transfer of huge amounts of information.

Coding also allows for uniform documentation between medical facilities. The code for
streptococcal sore throat is the same in Arkansas as it is in Hawaii. Having uniform data allows
for efficient research and analysis, which government and health agencies use to track health
trends much more efficiently. If the CDC, for example, wants to analyze the prevalence of viral
pneumonia, they can search for the number of recent pneumonia diagnoses by looking for the
ICD-9-CM code 480.

Finally, coding allows administrations to look at the prevalence and effectiveness of treatment in
their facility. This is especially important to large medical facilities like hospitals. Like
government agencies tracking, say, the incidence of a certain disease, medical facilities can track
the efficiency of their practice by analyzing
Now that we understand the importance of this practice, lets take a look at the three types of
code that youll have to become familiar with as a medical coder.

THREE TYPES OF CODE YOULL HAVE

TO KNOW
There are three sets of code youll use on a daily basis as a medical coder.

ICD
The first of these is the International Classification of Diseases, or ICD codes.

These are diagnostic codes that create a uniform vocabulary for describing the causes of injury,
illness and death. This code set was established by the World Health Organization (WHO)
in the late 1940s. Its been updated several times in the 60-plus years since its inception. The
number following ICD represents which revision of the code is in use.

For example, the code thats currently in use in the United States is ICD-9-CM. This means its
the ninth revision of the ICD code. That -CM at the end stands for clinical modification. So
the technical name for this code is the International Classification of Diseases, Ninth Revision,
Clinical Modification. The clinical modification is a set of revisions put in place by the National
Center for Health Statistics (NCHS), which is a division of the Center for Medicare and
Medicaid Studies (CMS).

The Clinical Modification significantly increases the number of codes for diagnoses. This
increased scope gives coders much more flexibility and specificity, which is essential for the
profession. To give you an idea of how important the clinical modification is, the ICD-10 code,
which we will discuss more thoroughly in Course 2-5, has 14,000 codes. Its clinical
modification, ICD-10-CM, contains over 68,000.

ICD codes are used to represent a doctors diagnosis and the patients condition. In the billing
process, these codes are used to determine medical necessity. Coders must make sure the
procedure they are billing for makes sense with the diagnosis given. To return to our strep throat
example, if a coder listed a strep throat diagnosis as the medical justification for an x-ray, that
claim would likely be rejected.

ICD codes are updated by the NCHS on a regular basis. One of the biggest issues in codingand,
indeed, in the health information business at largeis the upcoming switchover from ICD-9-CM
to ICD-10-CM. Well cover this in upcoming courses, but the quick summary is that ICD-9-CM
has reached its capacity of use as a coding system. ICD-10-CM provides significantly more codes
and thus more flexibility and accuracy in the coding process. The entire medical system is set to
change over from ICD-9-CM to ICD-10-CM in October of 2015.

Lets turn our attention now to the two types of procedure codes.
CPT
Current Procedure Terminology, or CPT, codes, are used to document the majority of the
medical procedures performed in a physicians office. This code set is published and maintained
by the American Medical Association (AMA). These codes are copyrighted by the AMA and
are updated annually.

CPT codes are five-digit numeric codes that are divided into three categories. The first category
is used most often, and it is divided into six ranges. These ranges correspond to six major
medical fields: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and
Laboratory, and Medicine.

The second category of CPT codes corresponds to performance measurement and, in some
cases, laboratory or radiology test results. These five-digit, alphanumeric codes are typically
added to the end of a Category I CPT code with a hyphen.

Category II codes are optional, and may not be used in the place of Category I codes. These
codes are useful for other physicians and health professionals, and the AMA anticipates that
Category II codes will reduce the administrative burden on physicians offices by providing them
with more, and more accurate, information, specifically related to the performance of health
professionals and health facilities.

The third category of CPT codes corresponds to emerging medical technology.

As a coder, youll spend the vast majority of your time with the first two categories, though the
first will undoubtedly be more common.

CPT codes also have addendums that increase the specificity and accuracy of the code used.
Since many medical procedures require a finer level of detail than the basic Category I CPT code
offers, the AMA has developed a set of CPT modifiers. These are two-digit numeric or
alphanumeric codes that are added to the end of the Category I CPT code. CPT modifiers
provide important additional information to the procedure code. For instance, there is a CPT
modifier that describes which side of the body a procedure is performed on, and theres also a
code for a discontinued procedure.

HCPCS
Healthcare Common Procedure Coding System (HCPCS), commonly pronounced as
hick picks, are a set of codes based on CPT codes. Developed by the CMS(the same
organization that developed CPT), and maintained by the AMA, HCPCS codes primarily
correspond to services, procedures, and equipment not covered by CPT codes. This includes
durable medical equipment, prosthetics, ambulance rides, and certain drugs and medicines.

HCPCS is also the official code set for outpatient hospital care, chemotherapy drugs, Medicaid,
and Medicare, among other services. Since HCPCS codes are involved in Medicaid and
Medicare, its one of the most important code a medical coder can use.
The HCPCS code set is divided into two levels. The first of these levels is identical to the CPT
codes that we covered earlier.

Level II is a set of alphanumeric codes that is divided into 17 sections, each based on an area of
specificity, like Medical and Laboratory or Rehabilitative Services.

Like CPT codes, each HCPCS code should correspond with a diagnostic code that justifies the
medical procedure. Its the coders responsibility to make sure whatever outpatient procedure is
detailed in the doctors report makes sense with the listed diagnosis, typically described via an
ICD code.

Now that youve got a better idea of what each of these codes is and what they do, lets start
exploring each code set in a little more detail.

We are living in the age of high information and communication technology, and have long-
standing problem of improving human health in healthcare systems. The History of
Telemedicine provides a comprehensive and in-depth historical view of telemedicine from
ancient Greece to the present time. The authors started the task of writing the book with open
mind and put aside whatever preconceived notion or information about telemedicine. Bashshur
and Shannon really give historical insight to us on telemedicine. It would be a good guide and
rationale for the telemedicine.
Before authors began to trace and document the history of telemedicine, they reviewed the
published literature. They clearly realized the storytelling of telemedicine, because telemedicine
has a long and rich history and a story that has not been told, certainly not in its entirety. Two
common characteristics were revealed after careful review of the history of telemedicine in the
published literature. First, they tend to be very brief, often cursory or selective, sometimes
limited to a couple of paragraphs, and are typically included as a prelude to another topic.
Second, they are invariably simple accounts of early attempts to connect providers and patients
through telecommunication devices available at that time. They wanted to be guided solely by
the documented not by any preexisting ideas or notions, and therefore they were to minimize bias
in reporting.
The journey started with ancient societies and the early attempts to establish rudimentary
communication connectivity between settlements when faced with internal or external threats
and subsequently to establish clinical connectivity between patient and
physician/caregiver/priest. Thus, throughout this book, authors emphasized the continuing
underlying theme of connectivity between those in need of care and those who provide it.
Authors traced the history of long-distance communication from its humble origins in
semaphore, and much later the telegraph, and radio to advanced digital communication and
computer processing systems. Telemedicine provided the tools for connectivity when providers
and recipients of care could not be in the same place and time.
Authors wanted to achieve some measures of success in contributing to the full story of
telemedicine, the evolution of pertinent information and communication technology, and the
broader healthcare context, dating back to ancient societies and continuing through to the
present. They traced the origin of modern telemedicine applications in Europe and the fact that
those by a Dutch physician, Willem Einthoven, had been by long distance transfer of
electrocardiograms in 1905. Authors, after careful scrutiny of various sources, can attest that the
first clinical application in telemedicine was in cardiology, not radiology as some might have
contended. This was followed by radio consultations from medical centers in Norway, Italy, and
France in the 1920s, 1930s, and 1940s for patients aboard ships at sea and on remote islands. The
transmission of radiographic images began in the early 1950s in the United States, followed
shortly thereafter by similar experimentation in Canada. The first wave of organized
telemedicine programs in the United States began in the late 1950s. It lasted nearly two decades
and then came to a halt shortly after extramural funding was terminated. This was followed by a
hiatus that lasted nearly a decade, until a new wave of telemedicine projects and programs
developed at a much larger scale than its forerunner. This last wave was led by state-based and
province-based initiatives throughout the United States and Canada.
The search also led to some unexpected findings that may dispel other claims perpetuated
through verbal communication and presentations at professional meetings without adequate
verification. The deep roots of telemedicine are available in the archives of specialty areas in
medicine (such as cardiology and radiology) and telecommunications and electronics is not
necessarily available in the literature of telemedicine per se.
In probing the history of telemedicine from the ancient to the present time, authors discovered
continuity and change existing side by side in a dynamic evolutionary process. Continuity stems
from the convergence of medical care delivery and distance communication in various forms and
manifestations, whereas change reflects the never-ending advances in the character and
capability of the technology that enables telemedicine as well as other concurrent advances in
medical science and medical practice.
The major perspective of the book is one of evolution, context, and transformation in the history
of telemedicine. However, authors paid special attention to the broader context for the
development of telemedicine, which also explains its endurance despite cycles of advancement
and retrenchment, of peaks and valleys in its long history from the ancient societies. Especially,
they were to see through the history of telemedicine by a reasonable understanding of the
healthcare context for its development and its persistence through numerous decades.
The book does not only review the comprehensive history of telemedicine, but also discuss the
telemedicine solution and proposed an assessing tool for it. It is the matrix for assessing
telemedicine, by which we can evaluate the benefits of telemedicine modality in three
perspectives: those of the providers, the clients or patients, and society at large.
Nowadays, the nomenclature of telemedicine is created newly as "u-Health" in which ubiquitous
technology is using to connect provider and patients in ubiquity. Technological system of u-
Health will be easily established by convergence among ubiquitous and biometric technology,
and mobile telecommunication infrastructure. However, the crucial point of the adoption and
success of telemedicine in even ubiquity environments needs enough to tightly harmonize with
the mainstream medicine.
The History of Telemedicine would give invaluable and experiential lessons to the present and
future direction of it. The book, reviewing about why and way of telemedicine from the past to
the present, provides to the stakeholders of telemedicine an interesting and insightful perspective.
Although not completely comprehensive review telemedicine experiences in the world, it
provides many lessons and thoughtful chances to the reader. It is recommended for not only
those who have special interests on telemedicine, but also those who are searching for new way
of solving the current pent-up demand or unmet need.
Rashid L. Bashshur, Gary W. Shannon
History of Telemedicine: Evolution, Context, and Transformation.
2009. Mary Ann Liebert, Inc.: New Rochelle (NY).

Glob J Health Sci. 2014 Nov; 6(6): 1118.

Published online 2014 Jun 24.doi: 10.5539/gjhs.v6n6p11

PMCID: PMC4825491

The Role of Nursing Informatics on Promoting Quality of Health

Care and the Need for Appropriate Education
Asieh Darvish,1 Fatemeh Bahramnezhad,1 Sara Keyhanian,2 and Mojdeh Navidhamidi1,3

Author information Article notes Copyright and License information

Abstract
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1. Introduction

1.1 History and Definition

Nurses has been working in the field of informatics near four decades, the term nursing
informatics has been considered a specialization in nursing resources since 1984 (Guenther
& Peters, 2006). Many aspects such as data recovery, ethics, patient care, decision support
systems, human-computer interaction, information systems, imaging informatics, computer
science, information science, security, electronic patient records, intelligent systems, e-
learning and telenursing have been added to the field. Hana has defined Nursing Informatics
as the application of IT in the nursing duties including education, management & practice in
1985. Integration of information science, computer science and nursing science to support
nursing practice and knowledge management was the definition offered in 1989 by Graves
and Corcoran. The American Nurses Association (ANA) published its aim and standards in
1994-1995 and presented the Nursing Informatics as a specialty that integrates nursing
science, computer and information science to provide data communication management,
knowledge and nursing work in 2001. Now most of nursing professionals believe that it is
defined as the integration of information technology and all aspects of nursing such as
clinical nursing, management, research or education (Guenther & Peters, 2006).

1.2 Competencies
The competency of nursing informatics specialists was determined through studying three
categories including computer skills, informatics knowledge and informatics skills. It
investigates four levels of nursing practice: beginning nurse, experienced nurse, informatics
specialist, and informatics innovator.
The following competencies were rejected: diagnostic coding, desktop publishing, managing
central facilities to enable data sharing and writing an original computer program (Staggers
et al., 2002). Some components of accepted competencies are shown below in brief.

1.2.1 Computer Skills

Selected computer skill competencies contain computerized searches and retrieving patient
demographics data, the use of telecommunication devices, the documentation of patient care,
the use of information technologies for improving nursing care, and the use of networks and
computer technology safely.

1.2.2 Informatics Knowledge

Selected informatics knowledge competencies are the recognition of the use or importance of
nursing data for improving practice, and the recognition of the fact that the computer can
only facilitate nursing care and that there are human functions that cannot be performed by
computers, the formulation of ethical decisions in computing, the recognition of the value of
clinicians involvement in the design, selection, implementation, and evaluation of systems
in health care, the description of the present manual systems, the definition of the impact of
computerized information management on the role of the nurse and the determination of the
limitations and the reliability of computerized patient monitoring systems.

1.2.3 Informatics Skills

Informatics skills competencies includes the interpretation of information flow within the
organization, the preparation of process information flow charts for all aspects of clinical
systems, the development of standards and database structures to facilitate clinical care,
education, administration or research. It also includes the development of innovative and
analytic techniques for scientific inquiry in nursing informatics and new data organizing
methods and research designs with the aim of examining the impacts of computer technology
on nursing, and the conducting of basic science research to support the theoretical
development of informatics. Information literacy skills, competencies, and knowledge are
investigated among educators, administrators and clinicians of nursing groups nationally.
1.3 The Importance of Nursing Informatics
The history, definition and competencies of nursing informatics indicate the importance of
this field. It shows nurses are integrated into the field of IT automatically. So they should be
able to deal with it successfully to improve quality of care outcome. In this regard it is
required to study the influence of nursing informatics on health care and make bold the
appropriate information technology educational needs for nurses.
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2. Method
An extensive literature search was performed by using databases Pubmed, Google Scholar,
Ovid, Science Direct and SID. Search terms were education, nursing; quality of health
care; nursing informatics and technology. The study was carried out from January to
April, 2014. A library search was also performed. As many as 135 articles were retrieved.
With a critical point of view, 40 articles in English were selected that specifically focused on
nursing informatics education and its influence on nursing outcomes and the quality of health
care (Staggers et al., 2002).
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3. Results
The study mentions the followings as the key elements of nursing informatics
implementation:

3.1 Health Care Promotion

The advantages of applying information technology in all aspects of nursing, including
clinical areas, management, education and research and its influence on health care have
been reviewed. Today, the subjects of clinical nursing information systems, decision support
systems and medical diagnostic systems are associated with collecting patient information.
Regarding the technology-rich environment, health care and hospital information systems
developers, the quality of care is improving. For increasing patient safety and its leading to
an evidence-based nursing, nursing informatics has been enhanced for students and graduates
by Columbia school of nursing. The study has proved that informatics competence is a
prerequisite to improving patient care (Bakken et al., 2003). Technology and using
multimedia integrated into nursing curriculum can promote the use of informatics tools as an
integral practice component and increase patient safety (Norton et al., 2006). Managers can
improve efficiency and performance through information systems and new technologies. In
addition, several studies have confirmed the impact of careful shift planning and efficient
management on nurses work and the quality of health care. Information is the source of all
management activities. Nursing care is an industry service and its product is patient care.
Information technology can promote the nursing management outcome. Internet-based nurse
scheduling systems are mostly designed according to the self-scheduling model and need
refining by the manager who overviews proper distribution, it causes uniform resource
allocation in scheduling and increases patient direct care time (Pierce et al., 2003).
Implementing information systems can provide better access to evidence; it can affect the
patient care quality and support evidence-based nursing. Software tools to facilitate research
are available in all medical fields (Kardan&Darvish, 2008). Nursing information system had
an influence on clinical patterns and decreased the time nurses spent on indirect care
(Darvish&Salsali, 2010). This is critical to the health care professionals to assess, apply,
report and manage data by the help of new tools of the information age (Hall, 1995).

3.2 Advanced Systems

Although using decision support systems can lead to a safer care, it may impair critical
thinking. The need for excessive working time could cause some delay in the nursing job and
reduce the quality of health care (Norton, 2006). Researchers recommended considering the
following:

-Involving nurse managers in the system selection and designing process

-Designing a simple and efficient process
-Recording a system-compatible guideline
-Improving the system speed
-Selecting hardware which can encourage nurses to use them
-Upgrading the system through innovation in information technology
Decision support systems have been defined to assist physicians to solve problems
that require specific decisions since 30 years ago. It is replacing the role of human
knowledge by formulating the knowledge in the system (Ting et al., 2008). Expert
systems are the most common types of clinical decision support systems and have
applications in show notes, diagnostic support, critical treatment plans, decision
support, prescriptions, recovery and the identification and the interpretation of
pictures, however, as stand-alone tools, are not able to replace human expertise.
These systems should be integrated with knowledge management. Several studies
have shown that the integration of implicit and explicit knowledge and management
of different types of knowledge will help to determine the best treatment plan.
Logical design is required for the success of these systems and seems to hardly have
been considered. The application of guides and easy access to up-to-date clinical
evidence and the cutting of duplicate tests could reduce medical mistakes and
improve quality of care, but there are some limitations (Montani&Bellazzi, 2002). To
increase the usefulness and acceptability of such systems, the ease of use, support
and maintenance combined with the ability of systems hardware, software
applications, integration with hospital information systems and patient records
should be considered (Holbrook et al., 2003). Including smart and intelligent tools in
diagnosis and treatment methods can reduce medical errors and harm as well as
financial loss for humans. Artificial intelligence and expert systems are used to help
the diagnosis.
3.3 Internet and Network
The first internet-based Nursing Informatics courses were offered by Duck University in
1997. Represented advantages were clearly defined and measurable learning outcomes and
real-world problems were introduced as the main component of instructional strategies.
There were some disadvantages like hardware and software problems, deficiency in
prerequisite skills, troubleshooting difficulties, and low internet access speed and poor time
management to master the material (Goodwin, 1997). The evaluation of an innovative
consumer health informatics intervention proved that the patient and nurses are satisfied with
the use of electronic and communication devices and home care (Kossman et al., 2006).
Nurses can have networks such as AJN and AMN now. In the world wide web, it is possible
to have a common network for nursing organizations and develop a forum to discuss nursing
issues and design online meetings (Rizzolo& DuBois, 1995). The other aspects of nursing
practice potential in the new decade are offering services from distance through telemedicine
or telenursing. In this regard, easy remote diagnostic software and hardware are designed to
facilitate E-health services. Tele-nurses can provide various services such as education,
patient monitoring and counselling through Internet facilities. Telenurses are satisfied with
their role. They care remotely using special skills and knowledge. It can cover nurse
shortages and the global demand for nurses (Darvish&Salsali, 2010). In a telenursing Survey
most of nurses believed that it is better to design educational programs for nurses to be able
to work as telenurse (Grady, 2007). Using online library resources and outreach programs
would be beneficial and produce positive outcomes for nurses (Wozar&Worona, 2003).
Information and communication technology progress provided the possibility of improving
health through e-education irrespective of time and place. Patient education systems on the
internet can increase patient satisfaction and influence their self-care behaviour. E-health
educational programs make people aware of disease management and increase coordination
with the health care professional team. It influences the life style and the prevention of
diseases such as cancer, HIV and chronic diseases. On the other hand, it empowers medical
groups by enhancing and upgrading their knowledge. The web-based computer simulation
educational program in crisis decreased medical errors in emergency departments.
Information technology application refers to providing simultaneous access to education in
specified locations which require huge spending. It decreases cost loss (Kardan&Darvish,
2007). Online access to journal articles prevents repeated research programs and makes
assessment easy. Online databases provided up-to-date article access and informed nurses
about new technologies, easy software and the results of investigations (Darvish, 2010).

3.4 Related Organizations Activity

National advisory council on nurse education and practice addresses nursing practice
challenges; and mentions electronic health records, patient monitoring systems, bar code
medication administration, computerised provider order entry, data capture tools, care
planning tools and telehealth; and the need to consider nursing shortage, reducing medical
errors, improve tracking of patient data, improve efficiency of data collection, improve
access to care, support national surrveilancecapabillities. These are also mentioned as ways
to address nursing education challenges: E-learning to deliver education, simulation to
deliver education, inclusion of Health Care IT in curricula, and faculty development for
health care. It centeralizes these as solutions which can improve capacity of nursing schools,
reduce faculty shortage, and increase health IT skills of graduating students. There are many
group projects and organizations which support nurses involvment for optimal use of IT in
their job. Some are introduced in the following:

-The National Coordinator for Health Information Technology (ONC)

-The American Health Information Community (AHIC)
-The Nationwide Health Information Network (NHIN)
-The Faculty Development: Integrated Technology into Nursing Education and
Practice Initiative (ITNEP)
-National Advisory Council on Nurse Education and Practice (NACNEP)
-National League of Nursing (NLN)
-National Institute of Health (NIH)
-National Institute of Nursing Research (NINR)
-North American Nursing Diagnosis International (NANDA)
-Technology Informatics Guiding Education Reform Initiative (TIGER)

It is reported that without proper training for nurses, efforts to integrate healthcare IT with
nursing practice will be hampered. It gives evidence that nurses are not getting adequate
training for IT usage (NACNEP annual report, 2009).

3.5 Need for Educational Programs

Due to the fast growth and development of technology, in order to effectively take advantage
of information technology in nursing outcome and quality of health care, educational
arrangement is recommended to strengthen nurses at different levels for implementing
information technology tools in all aspects of their profession.
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4. Conclusion
In todays world the potential for information and communication technology application is
increasing so that it can enhance the quality of nursing domains outcome (McNelis et al.,
2012). Nurses have the most communication with patients, and interact with technology
more frequently. Using technology should create a positive attitude in nursing productivity. It
is essential for nurses to be involved in the initial design of systems to improve the quality of
health care and change their culture in this regard (Darvish&Salsali, 2010), (Jenkins et al.,
2007).
Mediating technically and technologically on the borderline between medicine and nursing,
nurses have become known as the medical Goddesses in the form of Tele-nurses. Nurses
have got more authority in decision-making with the use of new technologies (Gassert,
1998). For successful implementation of the electronic health reporting system, nurses must
be knowledgeable about information technology, computer skills and informatics knowledge
and skills. In telenursing, the importance of data quality criteria, transparency and integrity,
authenticity, confidentiality, the updating of information, accountability, productivity,
standards and accessibility of health web sites should be considered (Darvish, 2008). The
NACNEP recommended to prepare nurses to adopt intelligent and quality-based information
technology use in patient care by implementing five strategies: providing core informatics
courses to nursing schools, educating nurses specialized in informatics skills who are able to
solve related issues, offering more powerful nursing care through the implication of
telecommunication projects, preparing more nursing faculties in the informatics field to
facilitate students skills enhancement and enhancing collaboration to advance informatics.
The benefits of extending nursing informatics strategies directly and indirectly influence
patient and people health positively (Matarrese&Helwig, 2000). Courses affect nursing
students perceptions about informatics (Jett et al., 2010); and they may learn at the BSc
level about patient-centered evidence-based care through the use of informatics tools, and get
informed about benefits such as promotion of safety, quality and effective clinical decisions
(Norton et al., 2006; Ainsley & Brown, 2009). The may even learn how remote care and
personal phone can improve nursing care in different areas such as psychiatric nursing
(Tseng et al., 2012;Goossen, 2007; Wittmann-Price, 2012). At the same time, nursing
workers are busy in the wards giving care. If they are not alert to new technologies, it will be
difficult to accept the new nurses ideas who are educated recently with a positive attitude to
the advantages of information technology. This group of nurses can be encouraged to be
integrated into the potential of E-learning as well as continuing education (Button, 2013),
based on the summit of technology informatics guide education reform (Schlak&Troseth,
2013). It seems necessary to prepare knowledgeable nurses to deal with selecting,
developing, implementing and evaluating IT to interpret data as usable knowledge and
information. In the nursing world, four domains should be empowered. Undergraduate and
diploma programs can be integrated with courses. Graduate programs can be designed.
Formal and informal continued educational programs for nurses on job and fellowships for
PhD graduated nurses can be useful. Trying to make different groups of nurses ready for the
ever-increasing speed of technology in the current century is possible, not only by parallel
opportunities of learning, but also with the help of evaluating tools such as Self-assessment
of nursing informatics competencies scale which can bring the same range of comprehention
about informatics implementation (Choi & Bakken, 2013). In conclusion, considering
nursing outcomes takes advantage of information technology; educational arrangement is
recommended to set short-term and long-term specialized courses focusing on the four target
groups. Informatics courses for nursing students continued educational programs for
registered nurses in work area, graduate programs at MSc and PhD levels for nurses and
fellowship programs for doctoral graduates are
recommended to be considered (Figure 1).
The proposed educational model for empowering nurses on the subject of nursing
informatics in four groups

It is essential that nurse educators incorporate the entire concept of informatics into the
education of nurses.

Conclusion and Recommendation

In this article, we are asking nurses to use skills that they already possessthose of designing
and using instruments that are conceptually congruent with their phenomena of interest but to
translate those skills to the informatics arena. Nurses must be mindful of the conceptualizations
on which computational tools are based, be aware of what types of information may be missing
or inaccurate, and at times even reject the use of unsuitable tools as inconsistent with nursing
knowledge and practice. As nurses reject existing tools, they have a unique opportunity to
describe tools that would be consistent with nursing conceptualization and to collaborate with
nursing informatics researchers to develop computational tools that will enable nurses to build
sound nursing knowledge and provide optimal care. The development of these tools will be
complex, requiring the combined expertise of nurse researchers, nurse clinicians, and nurse
informaticists. Collaboration and communication are therefore vital.
As the use of computers in health care becomes routine and the amount of information nurses
must locate, synthesize, and apply grows, nurses have a unique opportunity to ensure that
computer systems support rather than hinder nursing research and practice. Nurses must
critically consider the commitments on which their tools are based, recognize situations in which
the commitments are inconsistent with nursing conceptualization, and speak up when a better
tool is needed.

Go to:

Acknowledgements
It is hereby acknowledged colleagues and all those who assisted in conducting the study or
critiquing the manuscript. The main enthusiasm of this study came out from the international
symposium of telemedicine was held by Tehran University of Medical Sciences.
Go to:

References

1. Ainsley B, Brown A. The impact of informatics on nursing education: a review of the

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